Fibromyalgia and Cortisol Relationship

Diagnosis and Pathophysiology

Fibromyalgia is recognized as a complex condition characterized by abnormal pain processing and secondary features, not as a manifestation of adrenal insufficiency, according to the European League Against Rheumatism (EULAR) guidelines 1, 2
The EULAR guidelines for fibromyalgia management make no mention of treating underlying cortisol deficiency, instead focusing on pain management, exercise, and psychological interventions as primary treatments 1, 2
Symptoms attributed to fibromyalgia are very unspecific and could be related to multiple concomitant pathologies, but no solid etiopathogenic autoimmune link has been confirmed between fibromyalgia and these conditions 3, 4
True secondary adrenal insufficiency requires peak cortisol <500 nmol/L (<18 μg/dL) on ACTH stimulation testing, with clinical features of hypotension, collapse, and electrolyte abnormalities, as stated by the guideline society 5

Heated pool exercise, individually tailored aerobic and strength training programs, and cognitive behavioral therapy are evidence-based non-pharmacological treatments for fibromyalgia, recommended by the European League Against Rheumatism (EULAR) 1, 2
Pharmacological management includes tramadol for pain, antidepressants, and pregabalin—not corticosteroid replacement, as per the EULAR guidelines 1, 2
Adrenal insufficiency must be definitively excluded before attributing symptoms solely to fibromyalgia, particularly when patients have unexplained hypotension, collapse, or electrolyte abnormalities, according to the guideline society 5