Sen Gupta Piya, Grozinsky-Glasberg Simona, Drake William M, Akker Scott A, Perry Les, Grossman Ashley B, Druce Maralyn R
Department of Endocrinology, Barts & the London School of Medicine, QMUL, London, UK.
Clin Endocrinol (Oxf). 2014 Feb;80(2):246-52. doi: 10.1111/cen.12270. Epub 2013 Jul 29.
Bone mineral density (BMD) is influenced by multiple factors. Recent studies have highlighted a possible relationship between serotonin and BMD. Patients with neuroendocrine tumours (NETs) frequently have elevated urinary 5-hydroxy-indoleacetic acid (5-HIAA) levels, a serotonin metabolite. Evaluation of the relationship between 5-HIAA and BMD in patients with NETs may provide insights into the relationship between serotonin and BMD.
One-year audit of consecutive patients with NETs within two institutions. Relationships between urinary 5-HIAA and dual X-ray absorptiometry (DEXA)-scan-measured BMD were investigated by group comparisons, correlation and regression.
Of 65 patients with NETs, 19 did not participate or were excluded. Of 46 subjects evaluated (48·9% males, 63·8 ± 10·5 years, BMI 26·6 ± 4·4 kg/m(2) ) with 32 gastrointestinal, 9 pancreatic, 3 pulmonary and 2 ovarian NETs, 72·3% had the carcinoid syndrome. Median interval from diagnosis was 4·0 years (IQR 2·0-6·0); 41·3% had osteoporosis and 32·6% osteopaenia (WHO definition). The group with a higher urinary 5-HIAA had a lower hip BMD (total T-score and Z-score), confirmed on individual analysis (Spearman's rank correlation -0·41, P = 0·004; -0·44, P = 0·002, respectively); urinary 5-HIAA was not found to be an independent predictor for BMD on multiple linear regression analysis.
These data of patients with NETs with higher serotonin metabolites having a lower BMD at the hip in group and individual comparisons, warrants further evaluation. Urinary 5-HIAA measurement alone cannot be used to predict future BMD. A larger cohort with prospective design including fractures as a clinical outcome will aid these data in determining whether patients with NETs should be subject to targeted osteoporosis prevention.
骨矿物质密度（BMD）受多种因素影响。近期研究强调了血清素与BMD之间可能存在的关系。神经内分泌肿瘤（NETs）患者的尿5-羟吲哚乙酸（5-HIAA）水平（一种血清素代谢产物）常常升高。评估NETs患者中5-HIAA与BMD之间的关系可能有助于深入了解血清素与BMD之间的关系。
对两个机构内连续的NETs患者进行为期一年的审核。通过组间比较、相关性分析和回归分析研究尿5-HIAA与双能X线吸收法（DEXA）扫描测量的BMD之间的关系。
65例NETs患者中，19例未参与或被排除。在46例接受评估的受试者（48.9%为男性，63.8±10.5岁，BMI 26.6±4.4kg/m²）中，有32例胃肠道NETs、9例胰腺NETs、3例肺部NETs和2例卵巢NETs，72.3%患有类癌综合征。自诊断起的中位间隔时间为4.0年（四分位间距2.0 - 6.0）；41.3%患有骨质疏松症，32.6%患有骨质减少症（根据世界卫生组织的定义）。尿5-HIAA水平较高的组髋部BMD较低（总T值和Z值），个体分析得到证实（斯皮尔曼等级相关性分别为-0.41，P = 0.004；-0.44，P = 0.002）；在多元线性回归分析中，未发现尿5-HIAA是BMD的独立预测因子。
这些NETs患者的数据表明，在组间和个体比较中，血清素代谢产物较高的患者髋部BMD较低，这值得进一步评估。仅通过测量尿5-HIAA不能用于预测未来的BMD。一个更大规模的前瞻性队列研究，将骨折作为临床结局，将有助于利用这些数据确定NETs患者是否应接受针对性的骨质疏松预防。
