A case study recently reported a rare case of a patient who developed fibromyalgia during the course of a hormone imbalance disorder. The disorder was described as an excess of ACTH (adrenocorticotropic hormone), characteristic of Cushing’s disease, accompanied by a reduction of circulating thyroid hormone (hypothyroidism).
The case report, “Fibromyalgia in a Patient with Cushing’s Disease Accompanied by Central Hypothyroidism,” was published in the scientific journal Internal Medicine.
Fibromyalgia is a chronic disease characterized by general muscle pain, usually accompanied by fatigue or insomnia. Although it is unclear what causes fibromyalgia, alterations in hormone levels might be a trigger or play a part in the development of the disease.
The excess release of ACTH by the pituitary gland is the main characteristic of Cushing’s disease. This is frequently due to a benign tumor or an abnormal growth of the gland. Among the symptoms it causes are rounded face, obesity, thin skin, and proximal muscle weakness without pain.
The study reports the case of a 39-year-old Japanese woman who went to the hospital due to a six-month history of widespread muscle pain. The patient did not report any major health changes except that her face began to take on a more rounded shape four years before the date of the consultation.
Later, the patient developed spontaneous pain, tenderness, and exercise pain in her muscles. After a first attempt, the physicians could not determine the cause of her pain symptoms, and treatment with oral analgesics seemed to worsen her pain.
After a thorough biochemical and physical examination physicians were able to exclude a diagnosis of muscle inflammation due to infection, muscle fiber related disease, or autoimmune or inflammatory neuromuscular disorders.
Additional tests determined the patient had a hormonal imbalance characteristic of Cushing’s disease accompanied by hypothyroidism. And, through imaging techniques, physicians detected a 0.5 cm tumor in her pituitary gland.
After surgically removing the tumor, there was an overall improvement of her Cushing’s disease symptoms within six months. The patient also experienced a decrease in her widespread muscle pain during this period.
However, the spontaneous pressure and exercise pain in the muscles of her neck, chest, and extremities remained unresolved. This prompted the physicians to conclude that the patient met the diagnostic criteria for fibromyalgia.
“These findings suggest that the patient developed fibromyalgia in association with concomitant untreated Cushing’s disease and hypothyroidism, and the concomitant Cushing’s disease and hypothyroidism also exacerbated her fibromyalgia,” the authors wrote in their report. “To our knowledge, our patient is the first reported case of fibromyalgia associated with untreated Cushing’s syndrome.”
“Our case highlights the need to examine the endocrine function, including the pituitary, thyroid, and adrenal function, in conjunction with the assessment of characteristic physical findings, such as a Cushingoid appearance, in patients who present with muscle pain,” the team wrote.