Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia 30307.
Atlanta VA Medical Center, Decatur, Georgia 30033.
J Clin Endocrinol Metab. 2017 Jul 1;102(7):2416-2424. doi: 10.1210/jc.2016-3693.
Acromegaly has been associated with calcium-phosphate and bone turnover alterations. Controlled studies of these interactions are sparse.
To evaluate calcium and bone metabolism in active and treated acromegaly.
DESIGN/SETTING/PATIENTS: We conducted a controlled, prospective study at a tertiary referral center. We studied 22 patients with acromegaly referred for surgical or medical therapy (ACM) and 22 with nonfunctioning pituitary adenomas referred for surgery (control).
Calcium (serum and urine), phosphorus, parathyroid hormone (PTH), 25-hydroxy- and 1,25-dihydroxy-vitamin D, bone turnover markers [serum C-terminal telopeptide of type 1 collagen (CTX) and procollagen type 1 N-terminal propeptide (P1NP)], and cytokines [receptor activator of nuclear factor κB ligand (RANK-L) and osteoprotegerin (OPG)] at baseline and 3 to 6 months after treatment.
At baseline, the ACM group had lower PTH levels than controls (36.3 ± 13.9 pg/mL vs 56.0 ± 19.9 pg/mL) and higher phosphorus (4.34 ± 0.71 mg/dL vs 3.55 ± 0.50 mg/dL) (P < 0.01). Groups had similar levels of serum and urine calcium and 25-hydroxy- and 1,25-dihydroxy-vitamin D. The ACM group had higher bone turnover markers than control; P1NP and CTX were strongly correlated (r2 = 0.82, P < 0.05). CTX was dependent on age and disease group but not on sex or gonadal status. After treatment of acromegaly, serum calcium (9.52 ± 0.43 mg/dL to 9.26 ± 0.28 mg/dL), phosphorus (4.34 ± 0.71 mg/dL to 3.90 ± 0.80 mg/dL), and CTX (0.91 ± 0.75 ng/mL to 0.63 ± 0.68 ng/mL) decreased, while PTH increased (36.3 ± 13.9 pg/mL to 48.9 ± 16.7 pg/mL) (P < 0.01). 25-hydroxy-vitamin D, P1NP, and RANK-L/OPG ratio did not change significantly.
Acromegaly patients exhibited PTH-independent calcium-phosphate alterations and enhanced coupled bone formation and resorption. Within 6 months of treatment, bone resorption decreased, whereas RANK-L/OPG changes were inconsistent.
肢端肥大症与钙磷和骨转换改变有关。这些相互作用的对照研究很少。
评估活动期和治疗中的肢端肥大症患者的钙和骨代谢情况。
设计/地点/患者：我们在一个三级转诊中心进行了一项对照、前瞻性研究。我们研究了 22 例因手术或药物治疗（ACM）而就诊的肢端肥大症患者和 22 例因手术而就诊的无功能垂体腺瘤患者（对照组）。
基线时和治疗后 3-6 个月时的钙（血清和尿液）、磷、甲状旁腺激素（PTH）、25-羟维生素 D 和 1,25-二羟维生素 D、骨转换标志物[血清 1 型胶原 C 端肽（CTX）和前胶原 1 N 端前肽（P1NP）]和细胞因子[核因子 κB 受体激活剂配体（RANK-L）和骨保护素（OPG）]。
基线时，ACM 组的 PTH 水平低于对照组（36.3 ± 13.9 pg/mL 比 56.0 ± 19.9 pg/mL），磷水平较高（4.34 ± 0.71 mg/dL 比 3.55 ± 0.50 mg/dL）（P < 0.01）。两组的血清和尿液钙以及 25-羟维生素 D 和 1,25-二羟维生素 D 水平相似。ACM 组的骨转换标志物高于对照组；P1NP 和 CTX 呈强相关性（r2 = 0.82，P < 0.05）。CTX 依赖于年龄和疾病组，但不依赖于性别或性腺状态。肢端肥大症治疗后，血清钙（9.52 ± 0.43 mg/dL 至 9.26 ± 0.28 mg/dL）、磷（4.34 ± 0.71 mg/dL 至 3.90 ± 0.80 mg/dL）和 CTX（0.91 ± 0.75 ng/mL 至 0.63 ± 0.68 ng/mL）降低，而 PTH 增加（36.3 ± 13.9 pg/mL 至 48.9 ± 16.7 pg/mL）（P < 0.01）。25-羟维生素 D、P1NP 和 RANK-L/OPG 比值无明显变化。
肢端肥大症患者表现出甲状旁腺激素非依赖性钙磷改变，并伴有骨形成和吸收的偶联增强。在治疗 6 个月内，骨吸收减少，而 RANK-L/OPG 的变化不一致。
