The role of increased cerebrospinal fluid pressure in CFS and FM
Belgian researchers reviewed research literature to find characteristics signs that are shared with empty sella syndrome and suggest that moderate or intermittent increases in cerebrospinal fluid pressure are involved in causing FM and CFS and should stimulate further research into the causes of these conditions.
Review Plain Language Summary:
The cause of fibromyalgia (FM) and chronic fatigue syndrome (CFS) is not yet elucidated. Disturbances in the interactions between the hypothalamus, pituitary gland, and adrenal glands (the hypothalamo-pituitary-adrenal (HPA) axis) in FM and CFS may result in abnormal hormone production.
However, a novel hypothesis proposes that moderate increases in cerebral and spinal fluid pressure may underlie both FM and CFS. Increased cerebral pressure may impede blood flow in the pituitary gland, resulting in hormonal disturbances.
Indeed, it is well known that severely increased cerebral pressure can cause compression and flattening of the pituitary gland, potentially leading to pituitary hormone deficiency, termed empty sella syndrome. The sella (turcica) is a saddle-shaped notch in the bone at the base of the skull where the pituitary gland is located.
A search of the scientific literature revealed that increased cerebrospinal fluid pressure, obesity, female sex, headache and migraine, fatigue, visual disturbances, vertigo, hearing loss, and widespread pain were all more prevalent in empty sella, FM and CFS patients than in healthy individuals.
Furthermore, it was demonstrated that the injection of substances to stimulate pituitary hormone production resulted in similar responses, including reduced cortisol, growth hormone, luteinizing hormone, and thyroid-stimulating hormone production and increased prolactin production, in all three conditions compared to healthy individuals.
The findings of this review provide further support for the hypothesis that moderate or intermittent increases in cerebrospinal fluid pressure are involved in the pathogenesis of FM and CFS and should stimulate further research into the causes of these conditions.
The link between Empty Sella Syndrome, Fibromyalgia, and Chronic Fatigue Syndrome: The role of increased cerebrospinal fluid pressure, by Mieke Hulens, Wim Dankaerts, Ricky Rasschaert, Frans Bruyninckx, Peter De Mulder, Chris Bervoets in Journal of Pain Research 2023:16, Pages 205—219 [doi.org/10.2147/JPR.S394321] 25 January 2023
