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.
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.
J Pediatr. 2010 Jun;156(6):1001-1005. doi: 10.1016/j.jpeds.2009.12.027. Epub 2010 Mar 10.
To evaluate bone mineral density (BMD) in children with Cushing disease before and after transphenoidal surgery (TSS).
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.
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.
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.
评估库欣病患儿经蝶窦手术（TSS）前后的骨密度（BMD）。
回顾性分析了 35 例库欣病患儿的 Hologic 双能 X 射线吸收仪（DXA）扫描结果。其中 16 例患儿在 TSS 后 13-18 个月进行了随访 DXA 扫描。计算腰椎（LS）L1-L4 和股骨颈（FN）的 BMD 和骨矿物质表观密度（BMAD）。
术前，38%和 23%的患儿 LS 和 FN 存在骨质疏松。LS 的 BMD 和 BMAD Z 评分均差于 FN（-1.60±1.37 与-1.04±1.19，P=0.003）和（-1.90±1.49 与-0.06±1.90，P<0.001）；术后 LS 的 BMD 和 BMAD 改善更明显（0.84±0.88 与 0.15±0.62，P<.001；0.73±1.13 与-0.26±1.21，P=0.015）。青春期阶段、皮质醇水平和疾病持续时间对 BMD 无影响。
在库欣病患儿中，椎体 BMD 比股骨 BMD 受影响更严重，且这种影响与高皮质醇血症的程度或持续时间无关。LS 的 BMD 在 TSS 后显著改善；该组患儿的骨质疏松可能是可逆的。
