The Role of the HPA Axis in Fibromyalgia & ME/CFS

How the Hypothalamus, Pituitary, and Adrenal Glands Interact

HPA axis is an abbreviation for a subsystem in your body called the hypothalamic-pituitary-adrenal axis. It describes a complex set of interactions between two parts of the brain—the hypothalamus and the pituitary glands—and the adrenal (or suprarenal) glands that are located at the top of each kidney.

As a whole, the HPA axis is a major part of the system that controls your physiological reaction to stress. That covers psychological stress (the kind you feel when you're overwhelmed or upset) as well as physical stress, such as illness, trauma, and injury.

Long-term stress causes the overactivation of the HPA axis, leading to mood symptoms such as anxiety, depression, mood swings. It is also linked to a host of other health problems including diabetes, heart disease, irritable bowel disease, and less-understood disorders like fibromyalgia and chronic fatigue syndrome.

The HPA axis is involved in numerous functions such as body temperature, digestion, the immune system, mood, sexuality, and energy usage.

By understanding how the HPA axis works, scientists have come closer to unlocking the secrets of fibromyalgia and chronic fatigue syndrome.

Central Sensitivity Syndromes 

In fact, some research suggests that the HPA axis plays a role in all central sensitivity syndromes, the family of illnesses fibromyalgia, chronic fatigue syndrome, and several other conditions that are believed to be in.

All of these illnesses are related to hyper-sensitivities of the central nervous system, which is made up of your brain and the nerves of the spinal column.

The role of the HPA axis in these disorders is not yet fully understood by researchers. So far, however, research suggests that it does play some kind of underlying role. Studies suggest that:

  • Decreased HPA-axis activity leads to a lowered cortisol response to stress in chronic fatigue syndrome. (Cortisol is one of the primary stress hormones.)
  • Lower cortisol reactivity is tied to more severe chronic fatigue syndrome symptoms, according to research published in the journal Health Psychology in 2015.
  • Childhood stressors may lead to dysfunction of the HPA-axis, which may, in turn, contribute to the development of conditions involving central sensitivity.
  • Regular mild exercise, such as stretching, may improve the function of the HPA axis in people with fibromyalgia.
  • HPA-axis dysfunction may be responsible for impaired function of the fascia, which is a body-wide network of connective tissues, in people with fibromyalgia.

Some researchers have called for new treatment strategies that target the dysfunctional HPA axis in these conditions.

Dysfunction of the HPA axis is also believed to be linked to anxiety disorder, bipolar disorder, post-traumatic stress disorder (PTSD), and clinical depression.

Given the number of conditions its linked to, a treatment for HPA axis dysfunction could help many millions of people live fuller lives.

As researchers learn more about the HPA axis itself, they may uncover valuable information about the conditions related to its dysregulation, including how to treat and prevent them.

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Article Sources

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  1. Borsini A, et al. Childhood stressors in the development of fatigue syndromes: a review of the past 20 years of research. Psychological Medicine.  2014 Jul;44(9):1809-23. doi:10.1017/S0033291713002468

  2. Genc A, Tur BS, Aytur YK, et al. Does aerobic exercise affect the hypothalamic-pituitary-adrenal hormonal response in patients with fibromyalgia syndrome? J Phys Ther Sci. 2015 Jul;27(7):2225-31. doi:10.1589/jpts.27.2225

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