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Hypothalamic pituitary adrenal axis dysregulation in women with irritable bowel syndrome





West J Nurs Res. 2009 Nov;31(7):818-36.


Hypothalamic-pituitary-adrenal axis dysregulation in women with irritable bowel syndrome in response to acute physical stress.


Fitzgerald LZ, Kehoe P, Sinha K. University of California, Los Angeles, This email address is being protected from spambots. You need JavaScript enabled to view it..



Irritable bowel syndrome (IBS) supports the concept of a dysregulated hypothalamic-pituitary-adrenal (HPA) axis. This study investigates the neuroendocrine and psychological responses to the acute physical stress of a lumbar puncture (LP) in women with diarrhea-predominant IBS by assessing central and peripheral HPA activity and affective measures. Blood samples have been collected at baseline and immediately post- and 1 hr following LP from 13 women with IBS and 13 controls. Plasma adrenocorticotropic hormone (ACTH), cortisol, epinephrine, and norepinephrine levels are analyzed. A single measure of cerebrospinal fluid (CSF) concentrations of corticotropin-releasing factor (CRF(CSF)) and norepinephrine( CSF) is noted. Affective assessments are used to rate anxiety and depression with the Hospital Anxiety and Depression Scale (HADS) and acute mood state is rated using the Stress Symptom Rating questionnaire (stress, anxiety, anger, arousal). The women with IBS display blunted ACTH and cortisol responses to the LP along with a profile of affective responsiveness suggestive of chronic psychosocial stress, although no CRF(CSF) differences between groups are observed.


PMID: 19858523 [PubMed - in process]









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  • This is an interesting study as it provides a physiological mechanism that explains why comorbidity of IBS with chronic fatigue syndrome (ME/CFS) and fibromyalgia (FMS) is so common; numerous studies in these two conditions has also found a blunted ACTH and cortisol response suggestive of a dysfunctional HPA-axis/stress response.

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