Gruber Lucinda M, Nanda Sanjeev, Nippoldt Todd, Chang Alice Y, Bancos Irina
Division of Endocrinology, Diabetes, and Nutrition, Mayo Clinic, Rochester, MN, USA.
Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA.
J Pain Res. 2021 May 19;14:1323-1329. doi: 10.2147/JPR.S302291. eCollection 2021.
Patients with fibromyalgia (FM) may demonstrate low cortisol concentrations during diagnostic evaluation. However, it remains unclear whether low cortisol reflects underlying pituitary dysfunction. We aimed to determine if a subset of patients with FM have concomitant secondary adrenal insufficiency (SAI) and growth hormone deficiency (GH).
This is a retrospective study of all patients with FM diagnosed with SAI based on abnormal insulin tolerance test (ITT) between June 2002 and August 2019. Patients were excluded if they had other reasons for SAI. Measurements include cortisol and GH during ITT in all patients, and peak cortisol during cosyntropin stimulation test in a subset of patients.
We identified 22 patients (median age of 38 years (range 19-65), 18 (82%) women) diagnosed with secondary AI based on abnormal ITT (peak median cortisol level of 11 mcg/dL (range 5.4-17)). Concomitant GH deficiency was diagnosed in 19 (86%) patients. Cosyntropin stimulation test was performed in 14 (64%) patients and was normal in 11 (79%) (peak cortisol ≥18 mcg/dL). MRI pituitary imaging was performed in 20 patients and showed no significant pituitary pathology. All patients were started on physiologic glucocorticoid replacement, and 5 patients were started on GH replacement. Of the 13 patients with follow-up, 8 (62%) reported symptom improvement after starting treatment.
Patients with FM can have concurrent SAI and GH deficiency. Cosyntropin stimulation test should not be used to exclude SAI in patients with FM. Appropriate glucocorticoid and/or GH replacement may improve symptoms in some patients.
纤维肌痛（FM）患者在诊断评估期间可能表现出皮质醇浓度降低。然而，尚不清楚低皮质醇是否反映潜在的垂体功能障碍。我们旨在确定一部分FM患者是否同时存在继发性肾上腺功能不全（SAI）和生长激素缺乏（GH）。
这是一项对2002年6月至2019年8月期间所有基于胰岛素耐量试验（ITT）异常诊断为SAI的FM患者的回顾性研究。如果患者有其他SAI原因则被排除。测量包括所有患者ITT期间的皮质醇和GH，以及一部分患者促肾上腺皮质激素刺激试验期间的皮质醇峰值。
我们确定了22例患者（中位年龄38岁（范围19 - 65岁），18例（82%）为女性），基于ITT异常诊断为继发性肾上腺皮质功能减退（峰值皮质醇中位水平为11 mcg/dL（范围5.4 - 17））。19例（86%）患者同时被诊断为GH缺乏。14例（64%）患者进行了促肾上腺皮质激素刺激试验，其中11例（79%）结果正常（皮质醇峰值≥18 mcg/dL）。20例患者进行了垂体MRI成像，未显示明显的垂体病变。所有患者均开始接受生理性糖皮质激素替代治疗，5例患者开始接受GH替代治疗。在13例有随访的患者中，8例（62%）报告开始治疗后症状改善。
FM患者可同时存在SAI和GH缺乏。促肾上腺皮质激素刺激试验不应被用于排除FM患者的SAI。适当的糖皮质激素和/或GH替代治疗可能改善部分患者的症状。
