Hulens Mieke, Dankaerts Wim, Rasschaert Ricky, Bruyninckx Frans, De Mulder Peter, Bervoets Chris
Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.
Department of Neurosurgery, AZ Rivierenland, Bornem, Belgium.
J Pain Res. 2023 Jan 25;16:205-219. doi: 10.2147/JPR.S394321. eCollection 2023.
The etiopathogenesis of fibromyalgia (FM) and chronic fatigue syndrome (CFS) is not yet elucidated. Hypothalamo-pituitary-adrenal (HPA) axis dysfunction is reflected in the hormonal disturbances found in FM and CFS. Some study groups have introduced a novel hypothesis that moderate or intermittent intracranial hypertension may be involved in the etiopathogenesis of FM and CFS. In these conditions, hormonal disturbances may be caused by the mechanical effect of increased cerebrospinal fluid pressure, which hampers blood flow in the pituitary gland. Severe intracranial pressure may compress the pituitary gland, resulting in primary empty sella (ES), potentially leading to pituitary hormone deficiencies. The aim of this narrative review was to explore whether similar hormonal changes and symptoms exist between primary ES and FM or CFS and to link them to cerebrospinal fluid pressure dysregulation. A thorough search of the PubMed and Web of Science databases and the reference lists of the included studies revealed that several clinical characteristics were more prevalent in primary ES, FM or CFS patients than in controls, including increased cerebrospinal fluid pressure, obesity, female sex, headaches and migraine, fatigue, visual disturbances (visual acuity and eye motility abnormalities), vestibulocochlear disturbances (vertigo and neurosensorial hearing loss), and bodily pain (radicular pain and small-fiber neuropathy). Furthermore, challenge tests of the pituitary gland showed similar abnormalities in all three conditions: blunted adrenocorticotropic hormone, cortisol, growth hormone, luteinizing hormone, and thyroid stimulating hormone responses and an increased prolactin response. The findings of this narrative review provide further support for the hypothesis that moderately or intermittently increased cerebrospinal fluid pressure is involved in the pathogenesis of FM and CFS and should stimulate further research into the etiopathogenesis of these conditions.
纤维肌痛（FM）和慢性疲劳综合征（CFS）的病因发病机制尚未阐明。下丘脑 - 垂体 - 肾上腺（HPA）轴功能障碍反映在FM和CFS中发现的激素紊乱上。一些研究小组提出了一种新的假说，即中度或间歇性颅内高压可能参与FM和CFS的病因发病机制。在这些情况下，激素紊乱可能是由脑脊液压力升高的机械作用引起的，这会阻碍垂体的血液流动。严重的颅内压可能会压迫垂体，导致原发性空蝶鞍（ES），可能导致垂体激素缺乏。本叙述性综述的目的是探讨原发性ES与FM或CFS之间是否存在相似的激素变化和症状，并将它们与脑脊液压力调节异常联系起来。对PubMed和Web of Science数据库以及纳入研究的参考文献列表进行全面检索后发现，原发性ES、FM或CFS患者中比对照组更普遍存在几种临床特征，包括脑脊液压力升高、肥胖、女性、头痛和偏头痛、疲劳、视觉障碍（视力和眼球运动异常）、前庭蜗神经障碍（眩晕和神经性听力损失）以及身体疼痛（神经根性疼痛和小纤维神经病变）。此外，垂体激发试验在所有这三种情况下都显示出相似的异常：促肾上腺皮质激素、皮质醇、生长激素、黄体生成素和促甲状腺激素反应迟钝，催乳素反应增加。本叙述性综述的结果为脑脊液压力中度或间歇性升高参与FM和CFS发病机制的假说提供了进一步支持，并应激发对这些疾病病因发病机制的进一步研究。
