Catargi B, Tabarin A, Basse-Cathalinat B, Ducassou D, Roger P
Service d'Endocrinologie, Hôpital Haut-Lévêque, Bordeaux-Pessac.
Ann Endocrinol (Paris). 1996;57(3):203-8.
Both endogenous and exogenous glucocorticoid excess are well establish as causes of osteoporosis, however the reversibility of bone mass following the restauration of normal steroid levels is not well documented. In this longitudinal study, we mesured bone mineral density (expressed as Z-score) by dual-photon and X-ray absorptiometry of the lumbar spine (L2-L4) in 9 patients cured of Cushing's syndrome who were followed for the next 48 months (16-76). Initial Z-scores ranged from -2 to -1 standard-deviation (SD) in 6 patients consistent with osteopenia, and were below -3 SD in 2 patients consistent with osteoporosis. One patient developed lumbar spine fractures. There is no relationship between the severity of the Cushing's syndrome (assessed by the urinary free cortisol) and initial bone reduction (inital Z-score), nor between length of Cushing's symptoms and initial bone reduction. Our data show a marked variation (+74 +/- 9%) in bone mass in patients successfully treated for Cushing's syndrome. Seven patients completely recovered from steroid-induced osteoporosis, one patient partially recovered but remained osteopenic. One post-menopausal women presented several lumbar spine fractures despite successfull treatment of Cushing's syndrome. This longitudinal study confirms that if steroid-induced bone loss may improve substantially by cure of steroid excess even without other treatment, osteoporosis may worsen particularly in post-menopausal women. These results are important to take into account to properly manage patients with steroid-induced osteoporosis.
内源性和外源性糖皮质激素过多均已被确认为骨质疏松症的病因，然而，在恢复正常类固醇水平后骨量的可逆性尚无充分文献记载。在这项纵向研究中，我们对9例库欣综合征已治愈的患者进行了为期48个月（16 - 76个月）的随访，通过双能光子和X线吸收法测量腰椎（L2 - L4）的骨密度（以Z值表示）。6例患者的初始Z值在 - 2至 - 1标准差（SD）之间，符合骨质减少；2例患者的初始Z值低于 - 3 SD，符合骨质疏松。1例患者发生了腰椎骨折。库欣综合征的严重程度（通过尿游离皮质醇评估）与初始骨量减少（初始Z值）之间、库欣症状持续时间与初始骨量减少之间均无关联。我们的数据显示，成功治疗库欣综合征的患者骨量有显著变化（+74±9%）。7例患者从类固醇诱导的骨质疏松症中完全恢复，1例患者部分恢复但仍为骨质减少。1例绝经后女性尽管库欣综合征得到成功治疗，但仍出现了几处腰椎骨折。这项纵向研究证实，如果即使不进行其他治疗，通过治愈类固醇过多，类固醇诱导的骨质流失可能会显著改善，但骨质疏松症可能会恶化，尤其是在绝经后女性中。在妥善管理类固醇诱导的骨质疏松症患者时，考虑这些结果很重要。
