GH/IGF1 axis disturbances in the fibromyalgia syndrome: is there a rationale for GH treatment?
- 433 Downloads
Fibromyalgia Syndrome (FMS) is a frequent idiopathic condition in which patients experience intense pain in specific tender points, profound fatigue and sleep disturbances. Although pain had not account so far in growth hormone deficiency syndrome (GHD) description, symptoms of FMS are very similar; and there is strong evidence of decreased GH secretion at least in a subset of FMS patients. Is there an overlap of the two diseases? A systematic Medline/Embase search for preliminary proof-of-concept trials, but also larger placebo-controlled studies, have shown that GH replacement in low-IGF1 patients can significantly improve some symptoms of FMS and quality of life, suggesting a direct causal effect of GH deficiency. Despite the use of relatively high doses of GH in these patients, treatment seems to be well tolerated. Several mechanisms of action for GH in FMS relief have been suggested, including both central modulation of pain and peripheral musculo-tendinous effects, as already described in classic GHD.
KeywordsAdult growth hormone deficiency Fibromyalgia Growth hormone GH resistance IGF1 Quality of life
Conflict of interest
Receiving fees for lecturing and advisory boards from Ipsen and Merck (GC), and Novartis and Pfizer (FFC).
- 1.Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, Tugwell P, Campbell SM, Abeles M, Clark P, Fam AG, Farber SJ, Fiechtner JJ, Franklin CM, Gatter RA, Hamaty D, Lessard J, Lichtbroun AS, Masi AT, Mccain GA, Reynolds WJ, Romano TJ, Russell IJ, Sheon RP (1990) The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Report of the multicenter criteria committee. Arthritis Rheum 33:160–172PubMedCrossRefGoogle Scholar
- 14.Department of Health (2006) The musculoskeletal services framework. Department of Health, LondonGoogle Scholar
- 19.Bennett RM (1989) Beyond fibromyalgia: ideas on etiology and treatment. J Rheumatol 19:185–191Google Scholar
- 25.Cuneo RC, Judd S, Wallace JD, Perry-Keene D, Burger H, Lim-Tio S, Strauss B, Stockigt J, Topliss D, Alford F, Hew L, Bode H, Conway A, Handelsman D, Dunn S, Boyages S, Cheung NW, Hurley D (1998) The Australian multicenter trial of growth hormone (GH) treatment in GH-deficient adults. J Clin Endocrinol Metab 83(1):107–116PubMedGoogle Scholar
- 39.Cuatrecasas G, Alegre C, Fernandez-Solà J, Gonzalez MJ, Garcia-Fructuoso F, Poca-Dias V, Nadal A, Cuatrecasas G, Navarro F, Mera A, Lage M, Peinó R, Casanueva F, Liñan C, Sesmilo G, Coves MJ, Izquierdo JP, Alvarez I, Granados E, Puig-Domingo M (2012) Growth hormone treatment for sustained pain reduction and improvement in quality of life in severe fibromyalgia. Pain 153(7):1382–1389PubMedCrossRefGoogle Scholar
- 42.Sverrisdottir YB, Elam M, Caidahl K, Soderling AS, Herlitz H, Johannsson G (2003) The effect of growth hormone (GH) replacement therapy on sympathetic nerve hyperactivity in hypopituitary adults: a double-blind, placebo-controlled, crossover, short-term trial followed by long-term open GH replacement in hypopituitary adults. J Hypertens 21:1905–1914PubMedCrossRefGoogle Scholar
- 46.Aberg ND, Johansson UE, Aberg MA, Hellstrom NA, Lind J, Bull C, Isgaard J, Anderson MF, Oscarsson J, Eriksson PS (2007) Peripheral infusion of insulin-like growth factor-I increases the number of newborn oligodendrocytes in the cerebral cortex of adult hypophysectomized rats. Endocrinology 148:3765–3772PubMedCrossRefGoogle Scholar
- 55.Commentary: The basis for medical therapy of fibromialgia with growth hormone. Malemud C. Pain 2012; 1342–1343Google Scholar
- 57.Jones KD, Deodhar AA, Burckhardt CS, Perrin NA, Hanson GC, Bennett RM (2007) A combination of 6 months of treatment with pyridostigmine and triweekly exercise fails to improve insulin-like growth factor-I levels in fibromyalgia, despite improvement in the acute growth hormone response to exercise. J Rheumatol 34(5):1103-1111PubMedGoogle Scholar