Journal of Pain Research (Jan 2023)
The Link Between Empty Sella Syndrome, Fibromyalgia, and Chronic Fatigue Syndrome: The Role of Increased Cerebrospinal Fluid Pressure
Abstract
Mieke Hulens,1 Wim Dankaerts,1 Ricky Rasschaert,2 Frans Bruyninckx,3 Peter De Mulder,4 Chris Bervoets5– 7 1Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; 2Department of Neurosurgery, AZ Rivierenland, Bornem, Belgium; 3Department of Physical Medicine & Rehabilitation, University Hospitals of Leuven, Leuven, Belgium; 4Department of Anesthesiology and Pain Therapy, Imelda Hospital, Bonheiden, Belgium; 5Department of Neurosciences, KU Leuven, Leuven, Belgium; 6Department of Ophthalmology, University Hospitals of Leuven, Leuven, Belgium; 7Department Adult Psychiatry, University Psychiatric Center of KU Leuven, Leuven, BelgiumCorrespondence: Mieke Hulens, Department of Rehabilitation Sciences, KU Leuven, Overwegstraat 14, 3051 Sint-Joris-Weert, Leuven, Belgium, Tel +32 477 338003, Fax +32 16 329197, Email [email protected]: The etiopathogenesis of fibromyalgia (FM) and chronic fatigue syndrome (CFS) is not yet elucidated. Hypothalamo-pituitary-adrenal (HPA) axis dysfunction is reflected in the hormonal disturbances found in FM and CFS. Some study groups have introduced a novel hypothesis that moderate or intermittent intracranial hypertension may be involved in the etiopathogenesis of FM and CFS. In these conditions, hormonal disturbances may be caused by the mechanical effect of increased cerebrospinal fluid pressure, which hampers blood flow in the pituitary gland. Severe intracranial pressure may compress the pituitary gland, resulting in primary empty sella (ES), potentially leading to pituitary hormone deficiencies. The aim of this narrative review was to explore whether similar hormonal changes and symptoms exist between primary ES and FM or CFS and to link them to cerebrospinal fluid pressure dysregulation. A thorough search of the PubMed and Web of Science databases and the reference lists of the included studies revealed that several clinical characteristics were more prevalent in primary ES, FM or CFS patients than in controls, including increased cerebrospinal fluid pressure, obesity, female sex, headaches and migraine, fatigue, visual disturbances (visual acuity and eye motility abnormalities), vestibulocochlear disturbances (vertigo and neurosensorial hearing loss), and bodily pain (radicular pain and small-fiber neuropathy). Furthermore, challenge tests of the pituitary gland showed similar abnormalities in all three conditions: blunted adrenocorticotropic hormone, cortisol, growth hormone, luteinizing hormone, and thyroid stimulating hormone responses and an increased prolactin response. The findings of this narrative review provide further support for the hypothesis that moderately or intermittently increased cerebrospinal fluid pressure is involved in the pathogenesis of FM and CFS and should stimulate further research into the etiopathogenesis of these conditions.Keywords: HPA axis, intracranial hypertension, prolactin, growth hormone, cortisol, thyroid hormones, hormone levels
