Neuroendocrinology of CFS and Fibromyalgia

http://journals.cambridge.org/action/displayAbstract;jsessionid=F2EE2FEAA265F50F665EBAB76A7098E3.tomcat1?fromPage=online&aid=91581

Background. Disturbance of the HPA axis may be important in the pathophysiology of chronic fatigue syndrome (CFS) and fibromyalgia. Symptoms may be due to: (1) low circulating cortisol; (2) disturbance of central neurotransmitters; or (3) disturbance of the relationship between cortisol and central neurotransmitter function. Accumulating evidence of the complex relationship between cortisol and 5-HT function, make some form of hypothesis (3) most likely. We review the methodology and results of studies of the HPA and other neuroendocrine axes in CFS.

Method. Medline, Embase and Psychlit were searched using the Cochrane Collaboration strategy. A search was also performed on the King's College CFS database, which includes over 3000 relevant references, and a citation analysis was run on the key paper (Demitrack et al. 1991).

Results. One-third of the studies reporting baseline cortisol found it to be significantly low, usually in one-third of patients. Methodological differences may account for some of the varying results. More consistent is the finding of reduced HPA function, and enhanced 5-HT function on neuroendocrine challenge tests. The opioid system, and arginine vasopressin (AVP) may also be abnormal, though the growth hormone (GH) axis appears to be intact, in CFS.

Conclusions. The significance of these changes, remains unclear. We have little understanding of how neuroendocrine changes relate to the experience of symptoms, and it is unclear whether these changes are primary, or secondary to behavioural changes in sleep or exercise. Longitudinal studies of populations at risk for CFS will help to resolve these issues.

Correspondence:
Address for correspondence: Dr A. J. Cleare, Section of Neurobiology of Mood Disorders, Academic Department of Psychological Medicine, GKT School of Medicine and Institute of Psychiatry, 103, Denmark Hill, London SE5 8AF.
 

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Here's more proof for those who insist that because it doesn't show up on the basic first-round blood tests, it must be imaginary.  Hard evidence of neuroendocrine abnormalities that are invisible until these specific tests are done.

Do not let any doctor laugh at you or tell you it's all in your head until you've had thorough neurological and endocrinological tests done.  The first series of blood tests that are given to every patient should be relatively normal, because you don't have lupus, diabetes, etc. that those test for.