Subclinical Hypercortisolism among Outpatients Referred for Osteoporosis

16 October 2007 | Volume 147 Issue 8 | Pages 541-548

Background: Hypercortisolism is known to cause osteoporosis.

Objective: To evaluate the prevalence of subclinical hypercortisolism in participants referred for evaluation of osteoporosis.

Design: Cross-sectional study.

Setting: Two community hospitals and research institutes in Italy.

Patients: 219 patients without clinically overt hypercortisolism or other secondary causes of osteoporosis who were referred for evaluation of osteoporosis between January 2005 and December 2005.

Measurements: Bone mineral density was measured by using dual-energy x-ray absorptiometry, and hypercortisolism was assessed with serum cortisol levels after a dexamethasone suppression test. Also measured were 24-hour urinary free cortisol levels and midnight plasma cortisol levels.

Results: Seven of 65 patients with T-scores of 2.5 or less and vertebral fractures had subclinical hypercortisolism (prevalence, 10.8% [95% CI, 3.23% to 18.31%]). This prevalence was 4.8% (CI, 1.32% to 8.20%) among patients with osteoporosis. In multivariable analyses adjusted for age, sex, and body mass index, a positive dexamethasone suppression test result was associated with the presence of osteoporosis (odds ratio, 3.37 [CI, 1.78 to 6.43]; P < 0.001) and vertebral fractures (odds ratio, 1.70 [CI, 1.04 to 2.79]; P = 0.035).

Limitations: The study was conducted in a referral setting; its findings may not apply to the general population.

Conclusions: Subclinical hypercortisolism may be more common than is generally recognized in patients with osteoporosis in whom secondary causes of osteoporosis have been excluded.

Editors' Notes Context The Cushing syndrome is a well-recognized secondary cause of osteoporosis. Contributions The researchers looked for hypercortisolism in asymptomatic patients referred for osteoporosis testing. They identified 7 patients with the condition. Six had functioning adrenal masses and 1 had an adrenocorticotropic hormone–secreting pituitary adenoma. The prevalence of subclinical hypercortisolism among patients with T-scores of –2.5 or less and vertebral fractures was 10.8%. Caution The findings come from a referral setting and might not apply to patients in the community. Implication Subclinical hypercortisolism may be more common than is generally recognized in patients with osteoporosis. —The Editors

 

Author and Article Information

From "San Giuseppe-Fatebenefratelli" Hospital, Fatebenefratelli Research Association, University of Milan, Fondazione Policlinico, Mangiagalli e Regina Elena, Scientific Institute, Milan, Italy; "Casa Sollievo della Sofferenza" Scientific Institute, San Giovanni Rotondo, Foggia, Italy; and University "La Sapienza," Rome, Italy.

Potential Financial Conflicts of Interest: None disclosed.

Request for Single Reprints: Alfredo Scillitani, MD, Unit of Endocrinology, "Casa Sollievo della Sofferenza" Scientific Institute, Viale dei Cappuccini, San Giovanni Rotondo, 71013, Foggia, Italy; e-mail, alscill{at}tin.it.

Current Author Addresses: Drs. Chiodini and Arosio: Department of Medical Sciences, University of Milan, Fondazione Policlinico, Mangiagalli e Regina Elena, Scientific Institute, Via F. Sforza 35, 20122, Milan, Italy.

Drs. Mascia, Muscarella, Battista, and Scillitani: Unit of Endocrinology, "Casa Sollievo della Sofferenza" Scientific Institute, Viale dei Cappuccini, 71013, San Giovanni Rotondo, Foggia, Italy.

Dr. Minisola: Department of Clinical Sciences, University "La Sapienza," Rome, Italy.

Dr. Santini: Department of Clinical Chemistry, "Casa Sollievo della Sofferenza" Scientific Institute, Viale dei Cappuccini, 71013, San Giovanni Rotondo, Foggia, Italy.

Dr. Guglielmi: Department of Radiology, "Casa Sollievo della Sofferenza" Scientific Institute, Viale dei Cappuccini, 71013, San Giovanni Rotondo, Foggia, Italy.

Dr. Carnevale: Department of Internal Medicine, "Casa Sollievo della Sofferenza" Scientific Institute, Viale dei Cappuccini, 71013, San Giovanni Rotondo, Foggia, Italy.

Author Contributions: Analysis and interpretation of the data: I. Chiodini, M.L. Mascia, S. Muscarella, C. Battista, S. Minisola, M. Arosio, S.A. Santini, G. Guglielmi, V. Carnevale, A. Scillitani.

Drafting of the article: I. Chiodini, A. Scillitani.

Critical revision of the article for important intellectual content: S. Minisola, M. Arosio, G. Guglielmi, V. Carnevale, A. Scillitani.

Final approval of the article: I. Chiodini, S. Muscarella, C. Battista, S. Minisola, M. Arosio, G. Guglielmi, V. Carnevale, A. Scillitani, M.L. Mascia, S.A. Santini.

Statistical expertise: A. Scillitani.

Collection and assembly of data: I. Chiodini, M.L. Mascia, S. Muscarella, C. Battista, S.A. Santini, A. Scillitani.