Evidence of Defective Growth Hormone Response and Adaptive Hormonal Changes in Fibromyalgia^[*]

Abstract

Objective:

To investigate pituitary and growth hormone status in patients with fibromyalgia (FM) and their response to balneotherapy.

Materials and Methods:

This is a nonrandomized controlled trial performed with the outpatients and hospital staff. 20 FM patients diagnosed according to American College of Rheumatology (ACR) criteria and 20 healthy controls who volunteered to participate in the study were selected from 64 outpatients and 24 hospital staff. All of the participants completed the study except 1 FM patient. Both groups had balneotherapy by the supervision of a physiotherapist for totally 3 weeks (15 sessions). Analysis of adrenocorticotropic hormone (ACTH), growth hormone (GH), cortisol and insuline like growth factor-1 (IGF-1) were done before and after the balneotherapy sessions at the first and the last days of the study in both of the groups. Pain is evaluated by the number of tender points (NTP) by a pressure algometer.

Results:

Both of the groups showed non-significant hormonal changes after balneotherapy session at the 1^st day of the study, except IGF-1 increase in favor of FM patients. When the groups were compared by percent of changes, difference was found between the groups for change in GH, cortisol and IGF-1 levels. GH baseline values and IGF-1 were negatively correlated with the decrease in NTP in the FM patients.

Conclusion:

GH insensitivity and improper IGF-1 levels are observed in FM patients and it is found that decrease in tender points was in negative correlation with IGF-1 increase as a therapeutic response to balneotherapy.

Zusammenfassung

Ziel der Studie:

Untersuchung des Hypophysen- sowie Wachstumshormonstatus von Patienten mit Fibromyalgie (FM) und deren Reaktion auf Balneotherapie.

Methodik:

Es handelt sich hierbei um eine nicht-randomisierte kontrollierte Studie mit ambulanten Patienten und Krankenhausmit­arbeitern. 20 FM-Patienten diagnostiziert nach den Kriterien des American College of Rheumatology (ACR) und 20 gesunde Kontrollpersonen, welche freiwillig an der Studie teilnahmen, ­wurden aus 64 ambulanten Patienten sowie 24 Krankenhausangestellten ausgewählt. Alle Patienten beendeten die Studie mit Ausnahme eines FM-Patienten. Beide Gruppen erhielten für einen Zeitraum von insgesamt 3 Wochen (15 Sitzungen) eine durch Physiotherapeuten applizierte Balneotherapie. In beiden Gruppen erfolgte bevor und nach den Balneotherapieeinheiten an den jeweils ersten sowie letzten Tagen der Studie eine Analyse des Adrenocorticotropen-Hormons (ACTH), Wachstumshormons (GH), Cortisol und dem Insulin-ähnlichen Wachstumsfaktor 1 (IGF-1). Die Bewertung erfolgte anhand der von einem Druckalgometer gemes­senen Zahl an Nervendruckpunkten (NTP).

Ergebnisse:

Ausgenommen einem Anstieg an IGF-1 bei den FM-Patienten zeigten beide Gruppen keine signifikanten Veränderungen nach der Balneotherapiesitzung am ersten Studientag. Ein Vergleich der prozentualen Veränderungen beider Gruppen konnte jedoch einen Unterschied hinsichtlich der GH-, Cortisol- sowie IGF-1-Spiegel nachweisen. Sowohl die GH-Basiswerte als auch IGF-1 korrelierten hierbei negativ mit einem Abfall der NTP innerhalb der FM-Patienten.

Schlussfolgerung:

Bei FM-Patienten wurden GH-Unempfindlichkeit sowie unangemessene IGF-1-Level beobachtet. Zudem konnte ein negativer Zusammenhang zwischen der Reduktion von „tender points“ und einem Anstieg an IGF-1 als therapeutische Antwort auf die durchgeführte Balneotherapie nachgewiesen werden.

Key words

balneotherapy - fibromyalgia - growth hormone

Schlüsselwörter

Balneotherapie - Fibromyalgie - Wachstumshormon

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