HPA Axis

Role in Fibromyalgia & Chronic Fatigue Syndrome

The hypothalamus and pituitary are highlighted in blue.. Dorling Kindersley/Getty Images


HPA axis is an abbreviation for hypothalamic-pituitary-adrenal axis. It describes a complex set of interactions between two parts of the brain -- the hypothalamus and the pituitary gland -- and the adrenal or suprarenal glands at the top of each kidney.

The HPA axis is a major part of the system that controls your reaction to stress, trauma and injury. It also helps regulate things such as your temperature, digestion, immune system, mood, sexuality and energy usage.

Given that list of functions, it's not surprising that research links fibromyalgia and chronic fatigue syndrome with abnormalities in the HPA axis. In fact, some research suggests that this system plays a role in all central sensitivity syndromes (Gracely), which is an umbrella term for these illnesses and several others that are believed to be related to hyper-sensitive central nervous systems.

The role of the HPA axis in these disorders isn't fully understood, but so far, research suggests it plays an underlying role. Studies suggest:

  • Decreased HPA-axis activity leads to a lowered cortisol response to stress in chronic fatigue syndrome (Kempke);
  • Lower cortisol reactivity is tied to more severe chronic fatigue syndrome symptoms (Kempke);
  • Childhood stressors may lead to HPA-axis dysfunction, which may contribute to the development of these conditions (Borsini);
  • Regular mild exercise, such as stretching, may improve HPA-axis function in fibromyalgia (Genc);
  • HPA-axis dysfunction may impair function of the fascia in fibromyalgia (Liptan);
  • We need new treatment strategies that target the HPA axis (Tomas).

The HPA axis also is involved in anxiety disorder, bipolar disorder, post-traumatic stress disorder, clinical depression, burnout and irritable bowel syndrome.


Borsini A, et al. Psychological medicine. 2014 Jul;44(9):1809-23. Childhood stressors in the development of fatigue syndromes: a review of the past 20 years of research.

Genc A. Journal of physical therapy science. 2015 Jul;27(7):2225-31. Does aerobic exercise affect the hypothalamic-pituitary-adrenal hormonal response in patients with fibromyalgia syndrome?

Gracely RH, Schweinhardt P. Current rheumatology reviews. 2015;11(2):116-30. Programmed symptoms: disparate effects united by purpose.

Kempke S, et al. Health psychology. 2015 Dec 21. [Epub ahead of print] Self-critical perfectionism predicts lower cortison response to experimental stress in patients with chronic fatigue syndrome.

Liptan GL. Journal of bodywork and movement therapies. 2010 Jan;14(1):3-12. Fascia: A missing link in our understanding of the pathology of fibromyalgia.

Tomas C, Newton J, Watson S. ISRN neuroscience. 2013 Sep 30;2013:784520. A review of hypothalamic-pituitary-adrenal axis function in chronic fatigue syndrome.

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