Effects of Cushing disease on bone mineral density in a pediatric population.
OBJECTIVE
To evaluate bone mineral density (BMD) in children with Cushing disease before and after transphenoidal surgery (TSS).


METHODS
Hologic dual-energy x-ray absorptiometry (DXA) scans of 35 children with Cushing disease were analyzed retrospectively. Sixteen of the 35 patients had follow-up DXA scans performed 13 to 18 months after TSS. BMD and bone mineral apparent density (BMAD) for lumbar spine (LS) L1 to L4 and femoral neck (FN) were calculated.


RESULTS
Preoperatively, 38% and 23% of patients had osteopenia of the LS and FN, respectively. Both BMD and BMAD Z-scores of the LS were worse than those for the FN (-1.60 +/- 1.37 versus -1.04 +/- 1.19, P = .003), and (-1.90 +/- 1.49 versus -0.06 +/- 1.90, P < .001); postoperative improvement in BMD and BMAD were more pronounced in LS than in the FN (0.84 +/- 0.88 versus 0.15 +/- 0.62, P<.001; and 0.73 +/- 1.13 versus -0.26 +/- 1.21, P = .015). Pubertal stage, cortisol levels, and length of disease had no effect on BMD.


CONCLUSIONS
In children with Cushing disease, vertebral BMD was more severely affected than femoral BMD and this effect was independent of degree or duration of hypercortisolism. BMD for the LS improved significantly after TSS; osteopenia in this group may be reversible.
Lodish
Maya B
MB
Section on Endocrinology Genetics, Program on Developmental Endocrinology Genetics, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health, Bethesda, MD; Pediatric Endocrinology Inter-Institute Training Program, National Institutes of Health, Bethesda, MD. Electronic address: lodishma@mail.nih.gov.
Hsiao
Hui-Pin
HP
Section on Endocrinology Genetics, Program on Developmental Endocrinology Genetics, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health, Bethesda, MD; Department of Pediatrics, Kaohsiung Municipal HsiaoKang Hospital and College of Medicine, Kaohsiung Medical University, Taiwan.
Serbis
Anastasios
A
Section on Endocrinology Genetics, Program on Developmental Endocrinology Genetics, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health, Bethesda, MD.
Sinaii
Ninet
N
Biostatistics and Clinical Epidemiology Service, National Institutes of Health Clinical Center, Bethesda, MD.
Rothenbuhler
Anya
A
Section on Endocrinology Genetics, Program on Developmental Endocrinology Genetics, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health, Bethesda, MD.
Keil
Margaret F
MF
Section on Endocrinology Genetics, Program on Developmental Endocrinology Genetics, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health, Bethesda, MD.
Boikos
Sosipatros A
SA
Section on Endocrinology Genetics, Program on Developmental Endocrinology Genetics, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health, Bethesda, MD.
Reynolds
James C
JC
Department of Radiology, Nuclear Medicine Division, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, MD.
Stratakis
Constantine A
CA
Section on Endocrinology Genetics, Program on Developmental Endocrinology Genetics, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health, Bethesda, MD; Pediatric Endocrinology Inter-Institute Training Program, National Institutes of Health, Bethesda, MD.
D015502:Absorptiometry, Photon; D000293:Adolescent; D015519:Bone Density; D002648:Child; D003480:Cushing Syndrome / Q000503:physiopathology; D005260:Female; D005269:Femur / Q000503:physiopathology; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000652:urine; D008297:Male; D047748:Pituitary ACTH Hypersecretion / Q000503:physiopathology*; D012189:Retrospective Studies; D013131:Spine / Q000503:physiopathology
D006854:Hydrocortisone