Skeletal Diseases in Cushing's Syndrome: Osteoporosis versus Arthropathy

Kaltsas, G; Makras, P

dc.contributor.author	Kaltsas, G	en
dc.contributor.author	Makras, P	en
dc.date.accessioned	2014-03-01T02:00:39Z
dc.date.available	2014-03-01T02:00:39Z
dc.date.issued	2010	en
dc.identifier.issn	0028-3835	en
dc.identifier.uri	https://dspace.lib.ntua.gr/xmlui/handle/123456789/29122
dc.subject	Osteoporosis	en
dc.subject	Cushing's syndrome	en
dc.subject	Avascular necrosis	en
dc.subject	Bisphosphonates	en
dc.subject	Cortisol	en
dc.subject	Bone mineral density	en
dc.subject.classification	Endocrinology & Metabolism	en
dc.subject.classification	Neurosciences	en
dc.subject.other	GLUCOCORTICOID-INDUCED OSTEOPOROSIS	en
dc.subject.other	CORTICOSTEROID-INDUCED OSTEOPOROSIS	en
dc.subject.other	ENDOGENOUS HYPERCORTISOLISM	en
dc.subject.other	POSTMENOPAUSAL WOMEN	en
dc.subject.other	BONE	en
dc.subject.other	FRACTURES	en
dc.subject.other	EXCESS	en
dc.subject.other	PREMENOPAUSAL	en
dc.subject.other	TURNOVER	en
dc.subject.other	GENE	en
dc.title	Skeletal Diseases in Cushing's Syndrome: Osteoporosis versus Arthropathy	en
heal.type	journalArticle	en
heal.language	English	en
heal.publicationDate	2010	en
heal.abstract	Structural and functional impairment of the skeletal system remains an important cause of morbidity and disability in patients with Cushing's syndrome (CS). Glucocorticoid (GC) excess inhibits bone formation and calcium absorption from the gut, increases bone resorption, and alters the secretion of gonadotropin and growth hormones, cytokines and growth factors influencing bone. Both overt and subtle endogenous hypercortisolism affect bone, leading to vertebral fractures in up to 70% of patients. Fracture risk is related to age at onset, duration and severity of the disease and individual susceptibility to GCs that is genetically determined. Bone mineral density (BMD) measurement at the lumbar spine should be performed as a screening test in all patients with CS due to the preferential loss of trabecular bone induced by GCs. The higher risk of fractures at comparable BMD values with controls suggests that bone quality features, not assessed by routine BMD approaches, are also important and should be addressed when indicated applying specific radiological means. Successful treatment of GC excess is associated with improvement in bone mass which, although delayed and often incomplete, reduces the risk of osteoporotic fractures. Bisphosphonates can induce a more rapid improvement in BMD than cortisol normalization alone and can be used in patients with increased risks for further fractures and/or persistent hypercortisolemia to prevent further bone loss. Anabolic agents have not as yet been systemically used. Avascular necrosis, mainly of the femoral neck, and growth arrest in children are the most common skeletal disorders unrelated to osteoporosis encountered in patients with endogenous hypercortisolism. Copyright (C) 2010 S. Karger AG, Basel	en
heal.publisher	KARGER	en
heal.journalName	NEUROENDOCRINOLOGY	en
dc.identifier.isi	ISI:000281665500012	en
dc.identifier.volume	92	en
dc.identifier.spage	60	en
dc.identifier.epage	64	en