Units of Endocrinology, Ospedale "Casa Sollievo della Sofferenza", IRCCS, San Giovanni Rotondo, FG, Italy.
Unit of Internal Medicine, Ospedale "Casa Sollievo della Sofferenza", IRCCS, San Giovanni Rotondo, FG, Italy.
Endocrine. 2021 Jul;73(1):203-208. doi: 10.1007/s12020-021-02616-1. Epub 2021 Jan 23.
To evaluate the prevalence of less severe hypercortisolism (LSH) in fractured patients, and its association with hypertension, hyperglicemia, dyslipidemia, and obesity.
From July 2015 to October 2018 we enrolled all fractured patients admitted in our outpatient center for metabolic bone diseases, after exclusion of patients with secondary osteoporosis apart from diabetes and taking drugs known to affect bone metabolism. In all enrolled patients we collected data regarding gonadal status, history of diabetes, high blood pressure, dyslipidemia, and measured blood pressure, lipid profile, fasting glycaemia. Bone mass was measured with DXA at lumbar spine and femoral neck and the presence of fractures was evaluated with X-ray of thoracic and lumbar spine. All patients performed twice, 1 mg overnight dexametasone suppression test (DST) and, as confirmatory, 2day low-dose DST for diagnosing hypercortisolism.
We enrolled 101 fractured patients (75 females, 26 males), aged 65 ± 10.3 years. Five out of 101 (5.0%) patients were diagnosed as LSH. Fifty-five (54.5%) out of 101 were hypertensive, 57 (56.4%) dyslipidemic, 17 (16.8%) hyperglicaemic, 28(27.7%) obese patients. LSH tended to be associated to blood hypertension [5/5 vs 50/96 (Fisher exact test, p = 0.06) hypertensive patients]. Four out five LSH patients were hypogonadic.
Our study confirms that a nonnegligible percentage of fractured subjects actually presents an unrecognized hypercortisolism. Accordingly, regardless of age, we suggest to screen for hypercortisolism all patients with established osteoporosis and in particular hypertensive subjects.
评估骨折患者中较轻的皮质醇增多症（LSH）的患病率，及其与高血压、高血糖、血脂异常和肥胖的关系。
我们从 2015 年 7 月至 2018 年 10 月，纳入了在我们的代谢性骨病门诊就诊的所有骨折患者，除了患有除糖尿病以外的继发性骨质疏松症和服用已知影响骨代谢的药物的患者。在所有纳入的患者中，我们收集了有关性腺状态、糖尿病史、高血压、血脂异常的资料，并测量了血压、血脂谱、空腹血糖。使用 DXA 测量腰椎和股骨颈的骨量，并通过 X 射线检查胸腰椎评估骨折的存在。所有患者均进行了两次 1mg 过夜地塞米松抑制试验（DST），并进行了 2 天的低剂量 DST 以确诊皮质醇增多症。
我们纳入了 101 例骨折患者（75 名女性，26 名男性），年龄为 65±10.3 岁。101 例患者中有 5 例（5.0%）被诊断为 LSH。101 例患者中 55 例（54.5%）患有高血压，57 例（56.4%）血脂异常，17 例（16.8%）高血糖，28 例（27.7%）肥胖。LSH 与高血压相关[5/5 例与 50/96 例（Fisher 确切检验，p=0.06）高血压患者]。5 例 LSH 患者中有 4 例性腺功能减退。
我们的研究证实，相当比例的骨折患者实际上存在未被识别的皮质醇增多症。因此，无论年龄大小，我们建议对确诊骨质疏松症的所有患者，特别是高血压患者，筛查皮质醇增多症。
