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 DR. GAIL ADLER

Unraveling the Mystery of Neuroendocrine Abnormalities in FM and CFIDS

by Bonnie Gorman RN

You have heard many researchers talk about dysregulation of the Hypothalamic Pituitary Adrenal (HPA) Axis in both FM and CFIDS.  But what does that really mean?  Well Dr. Gail Adler will demystify that very complex topic for us.  Her lecture, Unraveling the Mystery of Neuroendocrine Abnormalities in FM and CFIDS, will be held on Saturday, December 7^th from 2PM-4PM at our new statewide lecture location, Milton Hospital, in Milton Mass. 

Dr. Gail Adler MD, PhD is a nationally known endocrinologist and researcher at the Harvard Medical School and the Brigham and Women's Hospital in Boston.  She has spent her career focusing on disorders of the endocrine system, particularly focusing on neuroendocrine dysfunction in FM.  She will share her considerable research expertise with us.

Dr. Adler is the principle researcher on a number of NIH grants including: "Regulation of Adrenal Function in Fibromyalgia"  In her initial proposal to NIH in 1994 she wrote, "Fibromyalgia (FM) is a disabling musculo-skeletal disorder of unknown etiology.  A number of clinical features of FM resemble those seen in patients with hypoadrenalism, or during steroid withdrawal, including fatigue, muscle and joint pain, depression, and impaired sleep and cognitive function.  The similarity of symptoms has led us and others to hypothesize that there is relative or absolute adrenal insufficiency in FM." 

"Several preliminary reports indicate decreased adrenal function in FM, and similar hypotheses have recently been postulated in patients with Chronic Fatigue Syndrome (CFS), a syndrome with many clinical similarities to FM.  In this study, we propose to test the hypothesis that patients with FM have inappropriately low basal adrenocortical activity and to determine the site or sites of abnormality that account for this difference.  Studies will compare the activity of the hypothalamic-pituitary-adrenal (HPA) axis in patients with FM with HPA axis activity and in matched normal healthy subjects."

The study is now in it's 8^th year, and going strong.  To date, Dr. Adler has consistently found low central corticotropin releasing hormone (CRH) in FM patients.  In a recent article she summarizes the available data on the neuroendocrine function in FM, including data on hormone secretion, circadian phase, and autonomic nervous system function.  "Studies suggest that there may be lower activity of a number of hypothalamic-pituitary peripheral gland axes and altered autonomic, nervous system function in patients with FM.  These reductions in activity are mild to moderate and do not result from alterations in circadian rhythms." 

"The reduced hormonal and autonomic responses appear to reflect an impairment in the hypothalamic or central nervous system response to stimuli rather than a primary defect at the level of the pituitary gland or the peripheral glands.  A combination of multiple, mild impaired responses may lead to more profound physiologic and clinical consequences as compared with a defect in only one system, and could contribute to the symptoms of FM."  (Neuroendocrine abnormalities in fibromyalgia. Curr Pain Headache Rep 2002 Aug;6(4):289-98)  She will translate all this for us.  Come join us to learn the latest information on this perplexing and critical research.

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DR. SAM DONTA

"The Interface of Lyme Disease with CFIDS and Fibromyalgia (FM): Diagnostic and Treatment Issues"

by Bonnie Gorman RN

Since Lyme disease has become an increasing problem for CFIDS and FM patients, Mass. CFIDS/FM Association has planned a special forum on Sunday November 3, 2002 with Dr. Sam Donta, a nationally recognized expert on Lyme disease.  The program will be held from 2PM-4PM at our new statewide lecture location, Milton Hospital, in Milton Mass.  Dr. Donta will discuss "the Interface of Lyme Disease with CFIDS and FM: Diagnostic and Treatment Issues."  Dr. Donta presented at the NIH's scientific meetings on CFIDS research.  His focus was Lyme Disease as a Model for CFIDS.  Dr. Donta is the Director of the Lyme Disease Unit at Boston Medical Center and a Professor of Medicine at BU Medical School

 

What does Lyme disease have to do with CFIDS and FM you might be asking?  Some people believe that Lyme disease may be one of the causative factor in both CFIDS and FM.  Others believe that some CFIDS and FM patients are really misdiagnosed chronic Lyme disease patients and vice versa.  Some believe that there is no such thing as chronic Lyme disease, instead these patients actually have CFIDS or FM.  We have asked Dr. Donta to help sort all this out.

What does Lyme disease look like anyway?  Just look at this list of symptoms.  It is a mirror image of CFIDS and FM symptoms. 

Symptoms of Lyme Disease

Unexplained fevers, chills, sweats; swollen glands; sore throat; unexplained weight changes; fatigue, exhaustion; cough, shortness of breath; chest pain/ heart palpitations; vision: double, blurry, pain, floaters, photophobia; nausea or vomiting; diarrhea or constipation; abdominal cramping/ pain; irritable bladder or bladder dysfunction; cystitis; joint pain and swelling; TMJ; stiffness of neck, back and joints; muscle pain or cramps; insomnia/ disturbed sleep; headaches; tingling, numbness; tremors; dizziness; poor balance; difficulty walking; and cognitive problems: difficulty concentrating, thinking, reading, and speaking.

 

The distinguishing characteristics of Lyme disease are tick bites (generally deer ticks) followed by a rash at bite site and or rashes at other sites.  But many patients don't even have a rash, so how do you even know you have been exposed to Lyme disease?  Confused yet?  You should be.  Come and learn the very latest information about this perplexing and important topic.

Lyme Disease is on the Rise

Since the federal Centers for Disease Control began tracking reports of Lyme disease in 1982, more than 145,000 cases have been documented by the agency.  Massachusetts is deep in a pocket of eight states in the Northeast that account for nearly 90 percent of Lyme disease reports in the country.  Many public health officials said the actual number of victims of Lyme is higher since not every case is reported to them.

''The whole state now is at risk,'' said Alfred DeMaria, Director of Communicable Disease Control for the state Department of Public Health.  ''It's not just the Cape [Cod], the islands and Cape Ann anymore. It's everywhere.''

At the same time, the medical community has been stymied in its efforts to reliably prevent, diagnose and treat the disease.  This winter, the manufacturer of the only approved vaccine to prevent Lyme disease pulled its product off the market citing poor sales.  That's left public health officials redoubling efforts to avoid what many are predicting: that reports of Lyme disease will set new records again this season.