Department of Endocrinology, Endocrinology Research Center, Xiangya Hospital of Central South University, Changsha, China.
Department of Endocrinology, The First People's Hospital of Xiangtan City, Xiangtan, China.
Ann Med. 2023;55(2):2282183. doi: 10.1080/07853890.2023.2282183. Epub 2023 Nov 20.
BACKGROUND/OBJECTIVE: Morphometric vertebral fractures (VFs) and osteopathy are prevalent and clinically significant complications of Cushing disease (CD). However whether they represent an early occurrence in the natural progression of the disease is an ongoing debate. This study aimed to assess the prevalence and determinants of VFs in patients newly diagnosed with CD.
This cross-sectional case-control study recruited 75 newly diagnosed CD patients and compared them with a control group of individuals without pituitary disorders or secondary forms of osteoporosis. Demographic, clinical and biochemical data were collected. The VFs were assessed using preoperative lateral chest radiography.
We found a significantly higher prevalence of VFs in the CD group than in the control group (58.7% vs. 14.5%; < 0.001). Among the CD patients with VFs, 27 (61.4%) showed moderate/severe VFs. The CD patients with VFs had significantly higher preoperative 8 am serum cortisol (8ASC) levels than those without VFs ( < 0.001). The preoperative 4 pm adrenocorticotropic hormone (ACTH) levels ( = 0.031), preoperative 0 am ACTH levels ( = 0.021) and systolic blood pressure were slightly higher in CD patients with VFs than in those without VFs ( = 0.028). A binary multiple logistic analysis showed that 8ASC was an independent predictor of VF risk ( = 0.003). The optimal cut-off value of the preoperative serum 8ASC level for predicting VFs was 22.18 ng/mL.
This is the first study reporting a high prevalence of radiologic VFs in recently diagnosed CD patients. VFs may represent an early manifestation of CD and may be related to cortisol levels. Therefore, VF assessment should be included in the workup during CD diagnosis.
背景/目的：形态计量学椎体骨折（VF）和骨病是库欣病（CD）的常见且具有临床意义的并发症。然而，它们是否代表疾病自然进展中的早期表现仍存在争议。本研究旨在评估新诊断的 CD 患者 VF 的患病率及其决定因素。
这项横断面病例对照研究纳入了 75 例新诊断的 CD 患者，并将其与无垂体疾病或继发性骨质疏松症的对照组个体进行比较。收集了人口统计学、临床和生化数据。使用术前侧位胸部 X 线片评估 VF。
我们发现 CD 组 VF 的患病率明显高于对照组（58.7%比 14.5%；<0.001）。在患有 VF 的 CD 患者中，27 例（61.4%）为中度/重度 VF。患有 VF 的 CD 患者的术前 8 点血清皮质醇（8ASC）水平明显高于无 VF 的患者（<0.001）。患有 VF 的 CD 患者的术前 4 点促肾上腺皮质激素（ACTH）水平（=0.031）、术前 0 点 ACTH 水平（=0.021）和收缩压略高于无 VF 的患者（=0.028）。二元多变量逻辑分析显示，8ASC 是 VF 风险的独立预测因素（=0.003）。术前血清 8ASC 水平预测 VF 的最佳截断值为 22.18ng/mL。
这是第一项报道新诊断的 CD 患者存在高患病率的影像学 VF 的研究。VF 可能代表 CD 的早期表现，并且可能与皮质醇水平有关。因此，在 CD 诊断期间应包括 VF 评估。
