Effect of 2 years of cortisol normalization on the impaired bone mass and turnover in adolescent and adult patients with Cushing's disease: a prospective study

Somma, Carolina Di; Pivonello, Rosario; Loche, Sandro; Faggiano, Antongiulio; Klain, Michele; Salvatore, Marco; Lombardi, Gaetano; Colao, Annamaria

doi:10.1046/j.1365-2265.2003.01713.x

Cited by 111 publications

(78 citation statements)

References 51 publications

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“…The remission from hypercortisolism is not followed by the improvement of the metabolic and vascular damage that persists as in the active phase of the disease (23). The recovery of bone mass after remission of the disease occurs a long time after the normalization of cortisol levels (24)(25)(26); commonly, the biochemical markers of bone turnover are more precocious than the changes of bone mineral density (BMD) in reflecting bone metabolism (27).…”

Section: Introductionmentioning

confidence: 99%

Persistent increase of osteoprotegerin levels after cortisol normalization in patients with Cushing's syndrome

Camozzi¹,

Sanguin²,

Albigier³

et al. 2010

European Journal of Endocrinology

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Objective: Osteoprotegerin (OPG) has been identified as a decoy receptor that inhibits osteoclast differentiation and, more recently, as a paracrine regulator of vascular calcification. OPG is suppressed by glucocorticoids (GC); however, results from experimental and clinical studies are not univocal. The aim of this study was to evaluate OPG and bone metabolism in patients with Cushing's syndrome (CS) before and after cure. Design and methods: Twenty-six patients with CS (all women, mean age: 39.1G11.9 years) and 24 ageand gonadal status-matched healthy women were studied for bone mineral density, bone metabolism, OPG, and receptor activator of nuclear factor-kB ligand at baseline. Twelve patients were also studied 6-18 months after surgery, with persistent normalization of cortisol levels. Results: OPG was significantly higher and osteocalcin (OC) was significantly lower in CS patients than in controls (OPG: 4.17G1.23 vs 2.95G0.79 pmol/l, PZ0.00001; OC: 15.0G6.1 vs 18.8 G6.8 ng/ml, PZ0.04 in CS and controls respectively). After cure, we found no difference in OPG levels, despite a significant increase in OC levels (from 16.4G11 to 37.2G15 ng/ml, PZ0.03). Conclusion: Patients with CS showed increased OPG serum levels that remained unchanged after recovery, despite a restoration of bone formation. We speculate that high levels of OPG could reflect the persistent damage of the GCs on cardiovascular system. European Journal of Endocrinology 162 85-90

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Section: Introductionmentioning

confidence: 99%

Persistent increase of osteoprotegerin levels after cortisol normalization in patients with Cushing's syndrome

Camozzi¹,

Sanguin²,

Albigier³

et al. 2010

European Journal of Endocrinology

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“…Indeed, GH deficiency impairs catch-up growth in short children cured from Cushing's disease and treatment with GH has proven greatly beneficial in these patients (6, 7). In adults, GH deficiency could contribute to metabolic derangements, increased cardiovascular risk and osteoporosis, which have been observed years after successful resolution of Cushing's disease (30,31,43). Accordingly, a study on a small group of patients has shown that adult patients with Cushing's disease who develop GH deficiency fare worse than age-matched patients with hypopituitarism due to other disorders, both prior to initiating rhGH therapy and during the course of treatment (17).…”

Section: Discussionmentioning

confidence: 99%

Significant GH deficiency after long-term cure by surgery in adult patients with Cushing’s disease

et al. 2007

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Objective: Impaired GH secretion usually accompanies Cushing's syndrome and a variable proportion of patients reportedly fail to recover normal GH secretion after successful treatment. This wide variability is most probably due to differences in the treatment (i.e. surgery and/or radiotherapy), timing of patient re-evaluation after surgery and dynamic tests employed to challenge GH secretion, and hinders a precise assessment of risk of GH deficiency after cure. The aim of the present study is to evaluate GH secretory status after long-term cure of Cushing's disease achieved by surgery alone. Design and methods: We studied 34 patients (27 females and 7 males, age range 21-68 years) formerly affected by Cushing's disease. Patients were studied 2-20 years (median 3.3 years) following remission of hypercortisolism; all patients underwent transsphenoidal surgery with the removal of an ACTHsecreting adenoma; repeat pituitary surgery for relapse was performed in two patients while bilateral adrenalectomy was necessary in two patients. In all subjects, the GH response to GHRHCarginine stimulation was evaluated. At the time of testing, 13 patients were still on steroid replacement therapy. Results: In long-term surgical remission, 22 patients (65.0%) presented subnormal GH secretion; partial GH deficiency (GH peak !16.5 mg/l) was found in 11 patients and severe GH deficiency (GH peak !9 mg/l) in another 11. Male gender and length of hypercortisolism were risk factors for postsurgical GH deficiency. Conclusions: This study demonstrates the presence of GH deficiency in a high percentage of patients with Cushing's disease after long-term remission of hypercortisolism obtained by surgery alone. Male gender and length of hypercortisolism are the most significant predictors of postsurgical GH deficiency. This finding is significant as it highlights that even the most favourable therapeutical course, i.e. remission achieved by surgery alone, is accompanied by impaired GH secretion. Assessment of GH secretion is therefore recommended for all patients cured from Cushing's disease, even if not submitted to radiotherapy. Studies on the clinical impact of GH deficiency and the use of GH replacement therapy seem warranted in patients cured from Cushing's disease.

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“…It was also reported that any impairment in bone maturation occurring during childhood can cause severe derangement of bone mass (10). Earlier studies have shown that g u r e 3 .…”

Section: T a B L E 3 Act H A N D Co R T I S O L L E V E L S I N Va mentioning

confidence: 99%

A Juvenile Case of Cushing's Disease Incidentally Discovered with Multiple Bone Fractures

et al. 2007

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Effect of 2 years of cortisol normalization on the impaired bone mass and turnover in adolescent and adult patients with Cushing's disease: a prospective study

Cited by 111 publications

References 51 publications

Persistent increase of osteoprotegerin levels after cortisol normalization in patients with Cushing's syndrome

Persistent increase of osteoprotegerin levels after cortisol normalization in patients with Cushing's syndrome

Significant GH deficiency after long-term cure by surgery in adult patients with Cushing’s disease

A Juvenile Case of Cushing's Disease Incidentally Discovered with Multiple Bone Fractures

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