Bone mineral density in patients with Cushing’s syndrome

Year 2024, , 185 - 191, 31.05.2024

Aysun Seker Dilek Gogas Yavuz

https://doi.org/10.5472/marumj.1485351

Abstract

Objective: Cushing’s syndrome is caused by the excessive secretion of cortisol or the intake of exogenous cortisol. Morbidity caused by
osteoporosis is a major complication that cannot be ignored. We conducted a study to evaluate bone density and fracture risk factors
in patients with Cushing’s syndrome.
Patients and Methods: This retrospective case-control study involved 176 patients diagnosed with Cushing’s syndrome [153 female
and 34 male patients] and 84 controls [72 female and 12 male patients]. Patients admitted to the clinics within the last eight years were
included in the analysis. We collected demographic, clinic laboratory data, and bone densitometry measurements from electronic
patient files. The classification of patients into normal, osteopenia, or osteoporosis groups is determined by their Body Mineral Density
measurements based on the World Health Organization criteria.
Results: Among the patients, 135 were diagnosed with Cushing’s disease and 41 with adrenal adenomas. Patients with Cushing’ syndrome
showed a higher incidence of osteopenia (11.4%) and osteoporosis (2.8%) when compared to the control group. No osteoporosis cases
were found in the control group, while nine cases of osteopenia were detected. Osteopenia was significantly more common in adrenal
adenoma patients than in those with pituitary Cushing’s disease. Osteopenia was present in 39.1% of adrenal Cushing’s patients, with
only 8.7% (n = 2) having osteoporosis. Osteopenia was observed in 11 patients (23.4%) with pituitary Cushing’s disease, while only 4
patients (8.5%) had osteoporosis.
Conclusions: Osteopenia is more prevalent in patients with adrenal Cushing’s syndrome.

Keywords

BMD, Bone, Cushing’s syndrome, Low bone density, Osteopenia, Osteoporosis

References

• TEMD. Adrenal ve Gonadal Hastalıklar Kılavuzu. Ankara: Bayt Bilimsel Araştırmalar Basın Yayın Ltd. Şti, 2018: 17-37.
• Limumpornpetch P, Morgan AW, Tiganescu A, et al. The effect of endogenous cushing syndrome on all-cause and causespecific mortality. J Clin Endocrinol Metab 2022; 107:2377- 88. doi: 10.1210/clinem/dgac265.
• Fleseriu M, Auchus R, Bancos I, et al. Consensus on diagnosis and management of cushing’s disease: a guideline update. Lancet Diabetes Endocrinol 2021; 9:847-75. doi: 10.1016/ S2213-8587(21)00235-7.
• Schmid HA. Pasireotide (SOM230): development, mechanism of action and potential applications. Mol Cell Endocrinol 2008; 286:69-74. doi: 10.1016/j.mce.2007.09.006.
• Mazziotti, G, Giustina, A. Glucocorticoid-induced osteoporosis. Osteoporosis in men (Second Edition) 2010; 415 – 21. doi.org/10.1016/B978-0-12-374602-3.00034-1.
• Mancini T, Doga M, Mazziotti G, Giustina A. Cushing’s syndrome and bone. Pituitary 2004; 7:249-52. doi: 10.1007/ s11102.005.1051-2.
• Biller BM, Grossman AB, Stewart PM, et al. Treatment of adrenocorticotropin-dependent Cushing’s syndrome: a consensus statement. J Clin Endocrinol Metab 2008; 93:2454- 62. doi: 10.1210/jc.2007-2734.
• Newell-Price J, Trainer P, Perry L, Wass J, Grossman A, Besser M. A single sleeping midnight cortisol has 100% sensitivity for the diagnosis of cushing’s syndrome. Clin Endocrinol (Oxf) 1995; 43:545-50. doi: 10.1111/j.1365-2265.1995.tb02918.x.
• Chandler WF, Schteingart DE, Lloyd RV, McKeever PE, Ibarra- Perez G. Surgical treatment of cushing’s disease. J Neurosurg 1987; 66:204-12. doi: 10.3171/jns.1987.66.2.0204.
• Buliman A, Tataranu LG, Paun DL, Mirica A, Dumitrache C. Cushing’s disease: a multidisciplinary overview of the clinical features, diagnosis, and treatment. J Med Life 2016; 9:12-8.
• Vestergaard P, Lindholm J, Jørgensen JO, et al. Increased risk of osteoporotic fractures in patients with cushing’s syndrome. Eur J Endocrinol 2002; 146:51-6. doi: 10.1530/eje.0.1460051.
• Trementino L, Appolloni G, Ceccoli L, et al. Bone complications in patients with cushing’s syndrome: looking for clinical, biochemical, and genetic determinants. Osteoporos Int 2014; 25:913-21. doi: 10.1007/s00198.013.2520-5.
• Warriner AH, Saag KG. Glucocorticoid-related bone changes from endogenous or exogenous glucocorticoids. Curr Opin Endocrinol Diabetes Obes 2013; 20:510-6. doi: 10.1097/ 01.med.000.043.6249.84273.7b.
• Lekamwasam S, Adachi JD, Agnusdei D, et al. A framework for the development of guidelines for the management of glucocorticoid-induced osteoporosis. Osteoporos Int 2012; 23:2257-76. doi: 10.1007/s00198.012.1958-1.
• Lacroix A, Feelders RA, Stratakis CA, Nieman LK. Cushing’s syndrome. Lancet 2015; 386(9996):913-27. doi: 10.1016/ S0140-6736(14)61375-1.
• Valassi E, Santos A, Yaneva M, et al. The european registry on cushing’s syndrome: 2-year experience. Baseline demographic and clinical characteristics. Eur J Endocrinol 2011; 165:383- 92. doi: 10.1530/EJE-11-0272.
• Füto L, Toke J, Patócs A, et al. Skeletal differences in bone mineral area and content before and after cure of endogenous cushing’s syndrome. Osteoporos Int 2008; 19:941-9. doi: 10.1007/s00198.007.0514-x.
• Pivonello R, De Leo M, Vitale P, et al. Pathophysiology of diabetes mellitus in cushing’s syndrome. Neuroendocrinology 2010; 92 Suppl 1:77-81. doi: 10.1159/000314319.
• Zografos GN, Perysinakis I, Vassilatou E. Subclinical Cushing’s syndrome: current concepts and trends. Hormones (Athens) 2014; 13:323-37. doi: 10.14310/horm.2002.1506.
• Zilio M, Barbot M, Ceccato F, et al. Diagnosis and complications of Cushing’s disease: gender-related differences. Clin Endocrinol (Oxf) 2014; 80:403-10. doi: 10.1111/ cen.12299.
• Liu X, Zhu X, Zeng M, et al. Gender-specific differences in clinical profile and biochemical parameters in patients with cushing’s disease: a single center experience. Int J Endocrinol 2015; 2015:949620. doi: 10.1155/2015/949620.
• Melmed S, Williams RH. Pituitary. In: Melmed S, Polonsky KS, Larsen RP, Kronenberg MH, eds. Williams Textbook of Endocrinology. Chapter 8. 12th Edition. Philadelphia: Elsevier, 2011: 12.
• Hur KY, Kim JH, Kim BJ, et al. Clinical guidelines for the diagnosis and treatment of cushing’s disease in korea. Endocrinol Metab (Seoul) 2015; 27:30:7-18. doi: 10.3803/ EnM.2015.30.1.7.
• Arnaldi G, Angeli A, Atkinson AB, et al. Diagnosis and complications of cushing’s syndrome: a consensus statement. J Clin Endocrinol Metab 2003; 88:5593-602. doi: 10.1210/ jc.2003-030871.
• Nieman LK, Biller BM, Findling JW, et al. The diagnosis of cushing’s syndrome: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2008; 93:1526-40. doi: 10.1210/jc.2008-0125.
• Heyn J, Geiger C, Hinske CL, et al. Medical suppression of hypercortisolemia in cushing’s syndrome with particular consideration of etomidate. Pituitary 2012; 15:117-25. doi: 10.1007/s11102.011.0314-3.
• Kaltsas G, Makras P. Skeletal diseases in cushing’s syndrome: osteoporosis versus arthropathy. Neuroendocrinology 2010; 92 Suppl 1:60-4. doi: 10.1159/000314298.
• Hamrahian AH, Yuen KC, Hoffman AR, et al. AACE/ACE disease state clinical review: medical management of cushing disease. Endocr Pract 2014; 20:746-57. doi: 10.4158/EP14147. RA.
• Dillard TH, Gultekin SH, Delashaw JB Jr, et al. Temozolomide for corticotroph pituitary adenomas refractory to standard therapy. Pituitary 2011; 14:80-91. doi: 10.1007/ s11102.010.0264-1.
• Colao A, Petersenn S, Newell-Price J, et al. A 12-month phase 3 study of pasireotide in cushing’s disease. N Engl J Med 2012 8; 366:914-24. doi: 10.1056/NEJMoa1105743.
• Elamin MB, Murad MH, Mullan R, et al. Accuracy of diagnostic tests for cushing’s syndrome: a systematic review and metaanalyses. J Clin Endocrinol Metab 2008; 93:1553-62. doi: 10.1210/jc.2008-0139.
• Carroll TB, Aron DC, Findling JW, Tyrrell B. Chapter 9. Glucocorticoids and adrenal androgens. Chapter 9. In: Gardner DG, Shoback D. eds. Greenspan’s Basic and Clinical Endocrinology. The McGraw-Hill Companies: 2011.
• Starke RM, Reames DL, Chen CJ, Laws ER, Jane JA Jr. Endoscopic transsphenoidal surgery for cushing disease: techniques, outcomes, and predictors of remission. Neurosurgery 2013; 72:240-7. doi: 10.1227/NEU.0b013e31827b966a.