Meta-analysis and meta-regression of hypothalamic-pituitary-adrenal axis activity in functional somatic disorders

Lineke M. Tak, Anthony J. Cleare, Johan Ormel, Andiappan Manoharan, Iris C. Kok, Simon Wessely, Judith G. M. Rosmalen*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

137 Citations (Scopus)

Abstract

Dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis is the most investigated biological risk marker in functional somatic disorders (FSDs), such as chronic fatigue syndrome (CFS), fibromyalgia (FM), and irritable bowel syndrome (IBS). Our aim was to assess whether there is an association between basal hypocortisolism and FSD and to identify potential moderators of this association. Meta-analysis on 85 studies revealed that although basal cortisol levels were generally lower in FSD subjects compared to controls, this association did not reach statistical significance (SMD -0.07, 95% CI -0.17 to 0.04, p = 0.241). However, when the three FSD were assessed separately, statistically significant basal hypocortisolism was observed in CFS subjects compared to controls (SMD -0.14, 95% CI -0.28 to 0.00, p = 0.047), but not in FM or IBS. When all potential moderators were entered into a meta-regression analysis, only type of FSD and female gender were significant independent predictors of basal hypocortisolism. In conclusion, we did not find evidence to consider all three main FSD as hypocortisolemic disorders, as significant reduction in basal cortisol compared to healthy controls was only found in CFS and in females with FM, but not in IBS. (C) 2011 Elsevier B.V. All rights reserved.

Original languageEnglish
Pages (from-to)183-194
Number of pages12
JournalBiological Psychology
Volume87
Issue number2
DOIs
Publication statusPublished - May-2011

Keywords

  • Chronic fatigue syndrome
  • Cortisol
  • Fibromyalgia
  • Functional somatic disorders
  • Hypothalamic-pituitary-adrenal axis
  • Irritable bowel syndrome
  • Meta-analysis
  • CHRONIC-FATIGUE-SYNDROME
  • IRRITABLE-BOWEL-SYNDROME
  • CORTICOTROPIN-RELEASING HORMONE
  • PRIMARY-FIBROMYALGIA-SYNDROME
  • POSTTRAUMATIC-STRESS-DISORDER
  • LOW-DOSE HYDROCORTISONE
  • 1 MU-G
  • MEDICALLY UNEXPLAINED SYMPTOMS
  • DEXAMETHASONE-SUPPRESSION TEST
  • RANDOMIZED CONTROLLED-TRIAL

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