HPA axis reactivity in chronic pelvic pain: Association with depression

Objectives. Chronic pelvic pain (CPP) is a frequent gynecological complaint. The pathophysiology of CPP is not fully understood. The aim of this study was to determine whether the presence of depressive symptoms is associated with hypothalamic-pituitary-adrenal (HPA) axis dysfunction in CPP. Methods. We measured neuroendocrine responses to a standardized social stress test and to a standard adrenocorticotropin (ACTH)_1-24 stimulation test in 18 patients with CPP, stratified based on the presence of high versus low self-reported depressive symptoms, compared with 24 controls. Results. Women with CPP and low depression exhibited enhanced ACTH responses to psychosocial stress compared with women with CPP and high depression, whereas there were no differences in cortisol responses. In the ACTH_1-24 stimulation test, CPP patients with high depression demonstrated enhanced cortisol responses. Conclusion. These results suggest a relationship between self-reported depression and reactivity of the HPA axis in patients with CPP.