Bone demineralization and vertebral fractures in endogenous cortisol excess: role of disease etiology and gonadal status.
BACKGROUND
The effects of endogenous cortisol (F) excess on bone mass and vertebral fractures have still not been thoroughly investigated. The aim of this cross-sectional case-control study was to investigate factors influencing bone demineralization and vertebral fractures in different conditions of F excess, i.e. Cushing's disease and adrenal and ectopic Cushing's syndrome.


METHODS
Eighty consecutive patients and 80 controls were prospectively enrolled: 37 patients (21 females) with pituitary ACTH-secreting adenoma, 18 (14 females) with adrenocortical adenoma, 15 (11 females) with adrenal carcinoma of mixed secretion, and 10 (three females) with ectopic ACTH secretion. The groups had similar age. At diagnosis, bone mineral density (BMD) was determined by the dual-energy x-ray absorptiometry technique at the lumbar spine (L1-L4) and femoral neck; vertebral fractures were investigated by standard spinal radiographs.


RESULTS
When comparing the groups with different etiology of F excess, the patients with ectopic ACTH secretion had higher F and lower BMD values than the other subgroups. Morning F (P = 0.03) and testosterone levels (P = 0.04) correlated with lumbar BMD. Vertebral fractures were found in 61 (76%) of the patients, were multiple in 52 (85%) of the cases, and clinically evident in 32 (52%). Only multiple fractures were more frequent in patients with ectopic ACTH hypersecretion (P < 0.05). Lumbar spine BMD was the best predictor of vertebral fractures (P < 0.01). Surprisingly, amenorrheic and eumenorrheic women had similar BMD values and fracture prevalence.


CONCLUSIONS
A high prevalence (76%) of vertebral fracture was revealed, regardless of the etiology of the patients' hypercortisolism. The harmful effects of F excess at the spine were partly counterbalanced by the increased androgen production but were not affected by gonadal status in women.
Tauchmanovà
Libuse
L
Department of Molecular, Clinical Endocrinology, and Oncology, Federico II University of Naples, via Sergia Pansini 5, 80131 Naples, Italy.
Pivonello
Rosario
R
Di Somma
Carolina
C
Rossi
Riccardo
R
De Martino
Maria Cristina
MC
Camera
Luigi
L
Klain
Michele
M
Salvatore
Marco
M
Lombardi
Gaetano
G
Colao
Annamaria
A
D000236:Adenoma / Q000097:blood; D000293:Adolescent; D000310:Adrenal Gland Neoplasms / Q000097:blood; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D000368:Aged; D015415:Biomarkers; D015992:Body Mass Index; D018488:Bone Demineralization, Pathologic / Q000209:etiology*; D002277:Carcinoma / Q000097:blood; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D008297:Male; D008875:Middle Aged; D010053:Ovary / Q000503:physiopathology*; D011446:Prospective Studies; D012307:Risk Factors; D016103:Spinal Fractures / Q000209:etiology*; D013737:Testis / Q000503:physiopathology*
D015415:Biomarkers; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone