Osteoporosis is a systemic disease characterized by bone mass and density loss leading to fragility fractures. Osteoporosis due to endocrine disorders is an example of secondary osteoporosis. The harmful effects on bones are common in patients harboring pituitary tumors (acromegaly, prolactinoma, Cushing's disease) and suffering from hypopituitarism. Increased fracture risk and high healthcare costs of fractured patients are their consequences. The coexistence of some of these disorders and hypogonadism results in severe osteoporosis. The influence of the certain diseases, their activity and therapy and accompanying hypogonadism on bone turnover, bone mineral density and fracture incidence is presented. KEYWORDS: acromegaly • bone density • bone turnover • Cushing's syndrome • fractures • hypopituitarism • prolactinoma • secondary osteoporosisOsteoporosis in pituitary diseases: lessons for the clinic Osteoporosis is a generalized disease defined as a loss of bone mass and strength that leads to fragility fractures [1]. Bone strength is a component of bone mineral density (BMD) and bone quality. In general, certain factors can influence bone metabolism and evoke osteoporosis. These factors include aging, lifestyle, exercise, diet, calcium intake and adverse effect of medications. Furthermore, secondary osteoporosis is caused by numerous diseases such as endocrine system diseases, disorders of the gastrointestinal or biliary tract, renal diseases and neoplasms. It is also known that pituitary adenoma can affect bone metabolism through the hypersecretion of certain hormones or secondary hypopituitarism [2]. In this study, we would like to present the association between the loss of bone mass and pituitary diseases such as acromegaly, hyperprolactinemia, Cushing's syndrome (CS) and hypopituitarism. It is important to know that these disorders not always have the same effects in individual patients, because of different age, sex and associated conditions. Coexistence of several of these diseases might result in severe osteoporosis.
AcromegalyAcromegaly is a rare disease caused by hypersecretion of growth hormone (GH), mainly from a pituitary tumor. It is known that patients with acromegaly have increased bone turnover as determined by changes in biochemical markers, calcium kinetics and histomorphometry [3]. Increased bone turnover suggests that acromegaly leads to the activation of both osteoblasts and osteoclasts [4]. Moreover, increased bone turnover was correlated with disease activity but was independent of gonadal status. In some in vitro experiments on human bone cells, it was shown that GH and IGF-1 may stimulate bone resorption by direct and indirect influence on formation, differentiation and activity of osteoclasts. On the other hand, it was shown that both GH and IGF-1 influence proliferation of osteoblasts but their differentiation is regulated only by IGF-1 and a lot of effects are the consequence of local secretion of IGFs [5]. In pre-pubertal period, GH is responsible for longitudinal bone growth. Duri...