Bone metabolism and mass in women with Cushing's syndrome and adrenal incidentaloma.
OBJECTIVE
The aim of this study was to compare bone turnover and mass in women with either Cushing's syndrome (CS) or adrenal incidentaloma (AI), which is a possible model for minimal hypersecretion of cortisol.


METHODS
We studied 15 patients with CS (seven premenopausal and eight postmenopausal women); 23 patients with AI (five premenopausal and 18 postmenopausal women) and 20 matched controls (seven premenopausal and 13 postmenopausal women). Alkaline phosphatase (ALP), bone alkaline phosphatase (bALP), osteocalcin (BGP), 24-h urinary pyridinoline (Pyr) and deoxypyridinoline (D-Pyr) and serum and 24-h urinary calcium and phosphorus were determined in all subjects. Bone mineral density (BMD) at lumbar spine and proximal femur was measured by dual energy X-ray absorptiometry (DEXA).


RESULTS
We found a significant reduction of BGP and serum phosphorus in CS and AI (P < 0.05) vs. controls and significantly lower levels of Pyr only in CS (P < 0.05) vs. AI and controls. Spinal and femoral BMD z-values were significantly lower (P < 0.05) in patients with CS (z-score: lumbar spine -1.44 +/- 1.5 and femoral neck -1.07 +/- 1; mean +/- SD) compared to AI and controls.


CONCLUSIONS
Our data show that hypercortisolism reduces osteoblastic function and bone resorption and that osteocalcin can contribute to the precocious diagnosis of silent glucocorticoid excess. Patients with active CS were found to have lower BMD, particularly at vertebral level.
Francucci
Cristiano Maria
CM
Division of Endocrinology, Department of Internal Medicine, University of Ancona, Italy. cm.francucci@ao-umbertoprimo.marche.it
Pantanetti
Paola
P
Garrapa
Gabriella Giuseppina
GG
Massi
Fernando
F
Arnaldi
Giorgio
G
Mantero
Franco
F
D000306:Adrenal Cortex Neoplasms / Q000378:metabolism* / Q000503:physiopathology; D000368:Aged; D000596:Amino Acids / Q000652:urine; D015519:Bone Density; D001842:Bone and Bones / Q000378:metabolism* / Q000503:physiopathology; D002118:Calcium / Q000097:blood / Q000652:urine; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D003480:Cushing Syndrome / Q000378:metabolism* / Q000503:physiopathology; D005260:Female; D005272:Femur Neck / Q000503:physiopathology; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000652:urine; D033162:Incidental Findings; D008159:Lumbar Vertebrae / Q000503:physiopathology; D008875:Middle Aged; D015675:Osteocalcin / Q000097:blood; D010758:Phosphorus / Q000097:blood / Q000652:urine
D000596:Amino Acids; D015675:Osteocalcin; D010758:Phosphorus; C015484:pyridinoline; C036020:deoxypyridinoline; D002118:Calcium; D006854:Hydrocortisone