Karavitaki N, Ioannidis G, Giannakopoulos F, Mavrokefalos P, Thalassinos N
Department of Endocrinology, Diabetes and Metabolism, Evangelismos Hospital, Athens, Greece.
Clin Endocrinol (Oxf). 2004 Feb;60(2):264-70. doi: 10.1111/j.1365-2265.2004.01968.x.
Cushing's syndrome (CS) is a well recognized cause of bone loss. Although many previous studies have shown decreased bone mineral density (BMD) in the lumbar spina and proximal femur of patients with endogenous CS, so far, the data estimating BMD in their peripheral skeleton are sparse. The aim of the present study was to evaluate BMD in the forearm and heel of women with newly diagnosed CS and to investigate its possible correlation with serum osteocalcin (BGP) and 24-hour urinary free cortisol levels (UFC).
BMD in the forearm (distal and ultradistal area) of 29 (13 premenopausal and 16 postmenopausal) women with newly diagnosed CS (18 with pituitary adenoma, 10 with adrenal tumor and 1 with ectopic) was measured by dual x-ray absorptiometry (DEXA) and was compared with BMD of 29 age, body mass index (BMI)- and oestrogen status matched healthy controls. Furthermore, in 18 (9 premenopausal and 9 postmenopausal) of the above patients (14 with pituitary adenoma, 5 with adrenal tumor and 1 with ectopic) broadband ultrasound attenuation (BUA) by quantitative ultrasound (QUS) of the heel was estimated and 18 age-, BMI- and oestrogen status matched healthy women served as controls. In all the patients serum BGP and UFC were measured at the time of diagnosis of CS.
Compared to their matched controls, BMD in the forearm and BUA values in the heel did not differ in the premenopausal women with CS, while in the postmenopausal group BMD in the forearm was decreased (P < 0.05) but not BUA. Apart from a weak negative correlation between serum BGP and BMD in the ultradistal site of the forearm in premenopausal women (P = 0.05), serum BGP and UFC did not show significant correlation with BMD or BUA.
BMD in the forearm is reduced only in postmenopausal women with newly diagnosed endogenous CS, while BUA in the heel is unaffected in both pre- and postmenopausal patients. Moreover, serum BGP and UFC do not seem to be relevant markers for assessing bone loss in the peripheral skeleton at the time of diagnosis of hypercortisolemia.
库欣综合征（CS）是公认的骨质流失原因。尽管此前许多研究表明，内源性CS患者的腰椎和股骨近端骨矿物质密度（BMD）降低，但到目前为止，评估其外周骨骼BMD的数据很少。本研究的目的是评估新诊断为CS的女性的前臂和足跟骨密度，并研究其与血清骨钙素（BGP）和24小时尿游离皮质醇水平（UFC）的可能相关性。
采用双能X线吸收法（DEXA）测量29例（13例绝经前和16例绝经后）新诊断为CS的女性（18例垂体腺瘤、10例肾上腺肿瘤和1例异位肿瘤）前臂（远端和超远端区域）的骨密度，并与29例年龄、体重指数（BMI）和雌激素状态匹配的健康对照者的骨密度进行比较。此外，对上述患者中的18例（9例绝经前和9例绝经后）（14例垂体腺瘤、5例肾上腺肿瘤和1例异位肿瘤）通过定量超声（QUS）评估足跟的宽带超声衰减（BUA），并以18例年龄、BMI和雌激素状态匹配的健康女性作为对照。在所有患者诊断CS时测量血清BGP和UFC。
与匹配的对照组相比，绝经前CS女性的前臂骨密度和足跟BUA值无差异，而绝经后组前臂骨密度降低（P<0.05），但BUA无变化。除绝经前女性前臂超远端部位血清BGP与骨密度之间存在弱负相关（P = 0.05）外，血清BGP和UFC与骨密度或BUA均无显著相关性。
仅新诊断为内源性CS的绝经后女性前臂骨密度降低，而绝经前和绝经后患者足跟的BUA均未受影响。此外，在诊断高皮质醇血症时，血清BGP和UFC似乎不是评估外周骨骼骨质流失的相关标志物。
