Cushing hastalığı, adrenal Cushing sendromu ve MACS'ta beslenme belirteçleri olarak PNI ve CONUT skorlarının kesitsel analizi: kemik sağlığı üzerine etkileri

Abstract

Amaç: Cushing hastalığı (CH), adrenal Cushing sendromu (ACS) ve hafif otonom kortizol salınımı (MACS) olan hastalarda hormonal profiller, beslenme durumu ve kemik sağlığı parametrelerini karşılaştırmayı amaçladık. Yöntem: Doğrulanmış endojen Cushing sendromu olan 110 yetişkin hasta (46 CH, 36 ACS, 28 MACS) ile tek merkezli, kesitsel bir çalışma yürütüldü. Biyokimyasal, hormonal ve beslenme parametreleri (Prognostik Beslenme İndeksi [PNI] ve Beslenme Durumunu Kontrol Etme [CONUT] skorları ile değerlendirildi) KMY (dual-enerji X-ışını absorpsiyometrisi [DXA]) ve 10-yıllık kırık riski (FRAX®) ile birlikte değerlendirildi. Bulgular: Kohort (medyan yaş: 53 yıl; %83,6 kadın) anlamlı hormonal farklılıklar gösterdi: CH hastalarında ACS/MACS'a kıyasla daha yüksek ACTH, kortizol ve DHEA-S düzeyleri (p<0,001), MACS hastalarında ise daha fazla deksametazon baskılanması (p<0,001) ve daha yüksek FSH/LH oranı (p<0,001) saptandı. Ancak tüm gruplar PNI, CONUT skoru ve (dis)beslenme durumları açısından benzerdi. Kemik sağlığı analizi, MACS'ta ACS'ye kıyasla daha yüksek femur boynu Z-skorları (p=0,027) dışında gruplar arasında benzer KMY ve FRAX® skorları ortaya koydu. Sonuç: Oldukça farklı hormonal sonuçlara sahip olmalarına rağmen CH, ACS ve MACS beslenme durumu ve kemik sağlığı üzerinde benzer etkiler göstermektedir. Hiperkortizolizm, beslenme özelliklerinden bağımsız olarak iskelet bozulmasının birincil itici gücü olarak kalmıştır.

Keywords

• Cushing sendromu
• kemik yoğunluğu
• beslenme durumu
• osteoporoz
• hiperkortizolizm

Cross-sectional analysis of PNI and CONUT scores as nutritional markers in Cushing's disease, adrenal Cushing syndrome, and MACS: implications for bone health

Abstract

Aims: We aimed to compare hormonal profiles, nutritional status, and bone health parameters among patients with Cushing’s disease (CD), adrenal Cushing syndrome (ACS), and mild autonomous cortisol secretion (MACS). Methods: A single-center, cross-sectional study was conducted involving 110 adults with confirmed endogenous Cushing syndrome (46 CD, 36 ACS, 28 MACS). Biochemical, hormonal, and nutritional parameters (assessed via Prognostic Nutritional Index [PNI] and Controlling Nutritional Status [CONUT] scores) were evaluated alongside BMD (dual-energy X-ray absorptiometry [DXA]) and 10-year fracture risk (FRAX®). Results: The cohort (median age:53 years; 83.6% female) demonstrated expected hormonal variations among CS subtypes. However, all groups were similar in terms of PNI, CONUT score, and (dys) nutritional states. Bone health analysis revealed similar BMD and FRAX® scores across groups, except for higher femoral neck Z-scores in MACS versus ACS (p=0.027). Osteoporosis (present in 38.2% overall) was associated with worse DXA parameters and elevated fracture risk (p<0.001) -independent of nutritional status. Conclusion: Despite having considerably different hormonal consequences, CD, ACS, and MACS demonstrate similar impacts on nutritional status and bone health. Hypercortisolism remained as the primary driver of skeletal deterioration regardless of nutritional properties. Nutritional assessment tools may require adaptation to account for cortisol-specific metabolic effects.

Keywords

• Cushing syndrome
• bone density
• nutritional status
• osteoporosis
• hypercortisolism

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