Unit of Endocrinology and Metabolic DiseasesFondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy
Unit of Endocrinology and Metabolic DiseasesFondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy.
Eur J Endocrinol. 2016 Dec;175(6):R265-R282. doi: 10.1530/EJE-16-0289. Epub 2016 Jul 13.
In recent years, the condition of subclinical hypercortisolism (SH) has become a topic of growing interest. This is due to the fact that SH prevalence is not negligible (0.8-2% in the general population) and that, although asymptomatic, this subtle cortisol excess is not harmless, being associated with an increased risk of complications, in particular of osteoporosis and fragility fractures. As specific symptoms of hypercortisolism are absent in SH, the SH diagnosis relies only on biochemical tests and it is a challenge for physicians. As a consequence, even the indications for the evaluation of bone involvement in SH patients are debatable and guidelines are not available. Finally, the relative importance of bone density, bone quality and glucocorticoid sensitivity in SH is a recent field of research. On the other hand, SH prevalence seems to be increased in osteoporotic patients, in whom a vertebral fracture may be the presenting symptom of an otherwise asymptomatic cortisol excess. Therefore, the issue of who and how to screen for SH among the osteoporotic patients is widely debated. The present review will summarize the available data regarding the bone turnover, bone mineral density, bone quality and risk of fracture in patients with endogenous SH. In addition, the role of the individual glucocorticoid sensitivity in SH-related bone damage and the problem of diagnosing and managing the bone consequences of SH will be reviewed. Finally, the issue of suspecting and screening for SH patients with apparent primary osteoporosis will be addressed.
近年来，亚临床皮质醇增多症（SH）的状况引起了越来越多的关注。这是因为 SH 的患病率不可忽视（普通人群中为 0.8-2%），尽管无症状，但这种轻微的皮质醇过多并非无害，它与并发症风险增加有关，特别是骨质疏松症和脆性骨折。由于 SH 中不存在皮质醇增多症的具体症状，因此仅依靠生化检测来诊断 SH，这对医生来说是一个挑战。因此，即使是评估 SH 患者骨骼受累的指征也存在争议，并且目前还没有相关指南。最后，SH 中骨密度、骨质量和糖皮质激素敏感性的相对重要性是一个新的研究领域。另一方面，SH 的患病率似乎在骨质疏松症患者中增加，在这些患者中，椎体骨折可能是皮质醇过多的隐匿性表现。因此，骨质疏松症患者中筛查 SH 的人群和方法是一个广泛争议的问题。本文将总结有关内源性 SH 患者的骨转换、骨密度、骨质量和骨折风险的现有数据。此外，还将回顾 SH 相关骨损伤中个体糖皮质激素敏感性的作用以及 SH 骨骼后果的诊断和管理问题。最后，将讨论疑似原发性骨质疏松症患者筛查 SH 的问题。
