Growth Hormone Perturbations in Fibromyalgia: A Review
Section snippets
GH Control in Healthy Individuals
GH is most clearly understood as a promoter of linear growth in children. It is a 191-amino-acid polypeptide hormone synthesized and secreted in a pulsatile manner by the anterior pituitary gland. GH enhances amino acid uptake and accelerates transcription and translation of mRNA, thus increasing protein synthesis. The following 2 hypothalamic hormones with opposing physiologic effects regulate GH secretion: (1) GHRH, a hypothalamic hormone consisting of 44 amino acids stimulates the secretion
Clinical Features
GH is necessary for the attainment of a normal adult height. GH deficiency (GHD) in children invariably results in significant growth retardation (31). There are many causes of childhood GHD, most are related to rare mutations of genes involved in GH and GHRH synthesis and their receptors (31). An interesting form of reversible GHD in children is called “psychosocial dwarfism” (32). This occurs in children coming from a hostile/abusive environment and is reversed by transfer to a supportive and
Patients and Methods
Studies included in this review were accessed through an English language search of Cochrane Collaboration Reviews (MEDLINE, CINAHL, EMBASE, PubMed, Healthstar, Current Contexts, Web of Science, PsychInfo, and Science Citation Indexes). Keyword MeSH terms included “fibromyalgia,” and “growth hormone” or “insulin-like growth factor 1”and resulted in 61 hits through December 2005. Additionally, 7 other articles were found through a hand search of journals, conference proceedings, and
Subjects
Overall, the 26 studies enrolled 2006 subjects (1262 FM women, 31 FM men, 89 female disease controls, 12 male disease controls, 583 female healthy controls, and 29 male healthy controls). Disease controls most commonly had CFS, osteoarthritis, rheumatoid arthritis, hypothyroidism, inflammatory rheumatic diseases, or myofascial pain syndrome. All subjects were adults and most were white, though often race or ethnicity was not disclosed.
Design, Methods, and Primary Outcome Measures
Three studies are randomized controlled treatment trials;
Discussion
In the past 2 decades, the diagnosis of FM has become more widely accepted as a legitimate clinical disorder due largely to objective findings of disordered central pain processing and sleep. GHD and FM patients share many of the same symptoms (Table 2) and these similarities led to the original investigations on the HP-GH-IGF-1 axis in FM patients (114, 115). As described in this review article, the disordered HP-GH-IGF-1 axis and its link to FM symptoms have now generated a respectable body
Acknowledgments
The authors express their gratitude to Dianne G. Adams, MPH for valuable assistance in preparing the manuscript. This work was supported by NIH/NINR Grant R01 NR008150-01.
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