Evidence for and pathophysiologic implications of hypothalamic-pituitary-adrenal axis dysregulation in fibromyalgia and chronic fatigue syndrome
Evidence for and pathophysiologic implications of hypothalamic-pituitary-adrenal axis dysregulation in fibromyalgia and chronic fatigue syndrome
复制标题
DOI：
10.1111/j.1749-6632.1998.tb09607.x
复制
发表时间：
1998-01-01
影响因子：
2.4
通讯作者：
Crofford, LJ
中科院分区：
文献类型：
--
作者：
Demitrack, MA;Crofford, LJ
慢性疲劳综合征（Chronic fatigue syndrome，CFS）是一种以严重疲劳和一系列弥漫性躯体症状为特征的疾病.我们的小组已经确定，受损的激活下丘脑-垂体-肾上腺（HPA）轴是一个重要的神经内分泌功能的条件。这一发现的相关性CFS的病理生理学支持的观察，这种疾病的发病和病程是由身体和情绪的压力。还值得注意的是，这种HPA失调不同于在神经性抑郁症中所见的HPA失调，但与其他临床综合征（例如，纤维肌痛）。HPA轴功能障碍如何发展尚不清楚，尽管最近的研究表明，肾上腺素能神经传递的紊乱和AVP活性的改变，AVP是一种重要的共促分泌素，沿着CRH，影响HPA轴功能。为了提供一个更精细的视图的性质下丘脑-垂体-肾上腺轴紊乱的CFS患者，我们研究了详细的，脉动的特点下丘脑-垂体-肾上腺轴在一组患者符合1994年疾病预防控制中心的CFS病例标准。结果表明，工作是一致的！认为CFS患者HPA轴活动减少，部分原因是中枢神经系统驱动受损。这些观察结果为开发更有效的治疗这种致残性疾病提供了重要线索。
Chronic fatigue syndrome (CFS) is characterized by profound fatigue anad an array of diffuse somatic symptoms. Our group has established that impaired activation of the hypothalamic-pituitary-adrenal (HPA) axis is an essential neuroendocrine feature of this condition. The relevance of this finding to the pathophysiology of CFS is supported by the observation that the onset and course of this illness is excerbated by physical and emotional stressors. It is also notable that this HPA dysregulation differs from that seen in melancholic depression, but shares features with other clinical syndromes (e.g., fibromyalgia). How the HPA axis dysfunction develops is unclear, though recent work suggests disturbances in serotonergic neurotransmission and alterations in the activity of AVP, an important co-secretagogue that, along with CRH, influences HPA axis function. In order to provide a more refined view of the nature of the HPA dusturbance in patients with CFS, we have studied the detailed, pulsatile characteristics of the HPA axis in a group of patients meeting the 1994 CDC case criteria for CFS. Results of that work are consistent with the! view that patients with CFS have a reduction of HPA axis activity due, in part, to impaired central nervous system drive. These observations provide an important clue to the development of more effective treatment to this disabling condition.