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weight in this study and there was an association between a high body-mass index and decreased dehydroepiandrosterone sulphate

levels,
which contradicted the findings by Maccario
and colleagues in healthy adults.212,219 In Maccario's study, the dehydroepiandrosterone-sulphate
levels were positively and independently associated with 24-hour urinary cortisol and insulinlike growth factor-I levels.219 Dessein and colleagues did not find any
significant relationship
between the levels of cortisol, serotonin, and
insulin-like growth factor-I and health status as
measured by the Fibromyalgia Impact Questionnaire212
Several studies have demonstrated that persons with fibromyalgia may have low levels of growth hormone (somatotropin) and insulin-like
growth factor-I. 205. Growth hormone is an
amino acid polypeptide hormone synthesized and secreted by the anterior pituitary. Its primary function is to promote linear growth. Growth hormone stimulates the
release of somatomedin C in the liver, which is required for the maintenance of normal muscle homeostasis.122 Approximately 70% of growth hormone is secreted
during slow-wave sleep and the amount of secreted growth hormone correlates with the amount of slow-wave sleep225 It was postulated that the poor sleep patterns
of persons with fibromyalgia could disrupt the nocturnal secretion of growth hormone.223 The secretion of growth hormone is under bidirectional control of the
hypothalamus, which contains both growth hormone releasing hormone as well as a growth hormone inhibiting hormone, known as somatostatin.ISO,IS2
decrease in growth hormone releasing hormone, or an increase in somatostatinThe somatostatin secretion is promoted by corticotropin-releasing hormone and thyroid
hormones, which is another reason to include thyroid dysfunction in the differential diagnosis of fibromyalgia.206,226-228 Leal-Cerro and colleagues concluded that
the decrease in growth hormone secretion was due to hypothalamic dysfunction.224 Norregaard and colleagues did not find any differences in somatomedin C levels
among persons with fibroMuscle Pain Syndromes 107
myalgia compared to healthy, but sedentary control subjects.229 They suggested that perhaps the difference in findings was due to selection procedures, as it is known
that physically active individuals have significantly higher somatomedin C levels than sedentary subjects.229,23o
An intriguing hypothesis regarding the etiology of fibromyalgia was postulated by Yue231 Notwithstanding observations by Ostensen and colleagues describing
worsening of symptoms during pregnancy with the last trimester experienced as the worst period, Vue noted that pregnant patients with fibromyalgia often experience
a remission of their symptoms during pregnancy with a return of symptoms within one or two months following delivery231,2J2
found that many patients with fibromyalgia responded positively to injections with botulinum toxin. These findings made Vue search for any agent or hormone that
would have an effect on the collagen of connective tissues, which resulted in the hypothesis that the pathogenesis of fibromyalgia is related to a systemic deficit of
relaxin, or an inability of the body to utilize relaxin231 He speculated that the increased use of birth control pills at a younger age may lead to relaxin deficiencies. A
fast onset of fibromyalgia appeared to occur in women following oophorectomies or hysterectomies. [n males, low levels of relaxin appeared to be related to low
levels of testosterone.
Relaxin is a polypeptide hormone related to insulin and insulin-like growth factors. It is secreted in females in the corpus luteum, decidua, and placenta and in males
in the prostate, from which the hormone is secreted mainly in seminal plasma. Relaxin is best known for its role during pregnancy and is known to promote
lengthening and softening of pelvic ligaments to facilitate the birth process. Relaxin does not only effect connective tissue extensibility, but plays a role in many other
biological processes.233 It is involved in the inhibition of uterine contractile activity and it stimulates the growth of the mammary gland. In males, relaxin is thought
to promote motility of spermatozoa234 Relaxin has a strong vasodilatory effect and it promotes the genera

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