Bone turnover in patients with endogenous Cushing’s syndrome before and after successful treatment

Szappanos, Ágnes; Tőke, Judit; Lippai, Dora; Patócs, Attila; Igaz, Péter; Szücs, Nikolette; Fütö, László; Gláz, Edit; Rácz, Kàroly; Tóth, Miklós

doi:10.1007/s00198-009-0978-y

Cited by 41 publications

(33 citation statements)

References 27 publications

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“…A high circulating cortisol concentration is both a stimulant of osteoclast activity and a suppressor of osteoblast activity, where only above a certain concentration does cortisol exert a significant resorptive effect on bone (Szappanos et al 2010). In support of the existence of a cortisol threshold, the current study found a significant positive correlation between serum cortisol concentration and serum ␤-CTX concentration on day 1 postexercise, which also corresponded to the highest cortisol response, and no correlation on days 2 to 4 postexercise where a lower postexercise cortisol concentration was recorded.…”

Section: B † † †mentioning

confidence: 99%

“…Moreover, cortisol is known to influence bone metabolism (Szappanos et al 2010). For instance, an increase in serum cortisol concentration following an ultra-marathon run was negatively correlated to bone formation markers (Mouzopoulos et al 2007), thus implicating cortisol and possibly metabolic stress as manipulates of exercise-associated bone turnover disruption.…”

Section: Introductionmentioning

confidence: 99%

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Bone resorption is suppressed immediately after the third and fourth days of multiday cycling but persistently increased following overnight recovery

Oosthuyse

Badenhorst

Avidon

2014

Appl. Physiol. Nutr. Metab.

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Previous studies suggest that seasoned cyclists may incur a low bone mineral density. This study investigated the effect of multiday cycling on bone turnover. Ten male cyclists completed 4 consecutive days of cycling for 3 h·day −1 . Sweat calcium excretion during exercise and serum calcium, cortisol, bone formation marker (bone alkaline phosphotase (bone-ALP)), bone resorptive marker (C-terminal telopeptide of type I collagen (␤-CTX)), and parathyroid hormone concentration were measured before and immediately postexercise each day. Serum ␤-CTX concentration increased from pre-to postcycling on days 1 and 2 (p = 0.01) (day 1: 0.31 ± 0.14 to 0.60 ± 0.4 ng·mL −1 ; day 2: 0.58 ± 0.26 to 0.87 ± 0.42 ng·mL −1 ), while serum bone-ALP concentration remained unchanged. Conversely, on days 3 and 4 both serum ␤-CTX (day 3: 0.60 ± 0.26 to 0.43 ± 0.26 ng·mL −1 , p < 0.05; day 4: 0.63 ± 0.21 to 0.43 ± 0.22 ng·mL −1 , p < 0.001) and bone-ALP (p < 0.01) response to exercise was suppressed. Interestingly, calcium lost to sweat and postexercise serum cortisol concentration were also significantly lower on days 3 and 4 than on day 1 (p < 0.05). However, both serum ␤-CTX (102%-124%) and bone-ALP (25%-29%) remained persistently elevated after 21 h of overnight recovery on all successive days compared with day 1 pre-exercise, where the percentage increase was greater for ␤-CTX (p < 0.05). Bone resorption, immediately following prolonged cycling, is acutely reduced by the third and fourth consecutive days and is coincident to reduced sweat calcium excretion and cortisol concentration. However, multiday cycling imposes a persistent increase in bone resorption following overnight recovery.Key words: bone turnover, bone metabolism, cycling, cortisol, sweat calcium, parathyroid hormone. Résumé :Des études antérieures suggèrent que des cyclistes d'expérience peuvent présenter une faible densité minérale osseuse. Cette étude analyse l'effet de plusieurs jours de vélo sur le renouvellement du tissu osseux. Dix cyclistes masculins participent à 4 jours consécutifs de vélo à raison de 3 h·jour -1 . Tous les jours, avant et immédiatement après l'exercice à vélo, on évalue l'excrétion de calcium dans la sueur au cours de l'exercice ainsi que les variables suivantes : calcium sérique, cortisol, marqueur de la formation osseuse (phosphatase alcaline osseuse (« ALP » osseuse)), marqueur de résorption osseuse (télopeptide c-terminal du collagène de type 1 (« ␤-CTX »)) et concentration de la parathormone. La concentration sérique de ␤-CTX augmente du début à la fin de l'exercice aux jours 1 et 2 (p = 0,01) (jour 1: de 0,31 ± 0,14 à 0,60 ± 0,4 ng·mL -1 ; jour 2: de 0,58 ± 0,26 à 0,87 ± 0,42 ng·mL -1 ), mais la concentration sérique d'ALP osseuse ne varie pas. Par contre, aux jours 3 et 4, la concentration sérique de ␤-CTX (jour 3: de 0,60 ± 0,26 à 0,43 ± 0,26 ng·mL -1 , p < 0,05; jour 4: de 0,63 ± 0,21 à 0,43 ± 0,22 ng·mL -1 , p < 0,001) et d'ALP osseuse (p < 0,01) diminue au cours de l'exercice. Curieusement, la perte de calcium dans la su...

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Section: B † † †mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Bone resorption is suppressed immediately after the third and fourth days of multiday cycling but persistently increased following overnight recovery

Oosthuyse

Badenhorst

Avidon

2014

Appl. Physiol. Nutr. Metab.

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“…[8][9][10][11] Nevertheless, many researchers have demonstrated a statistically significant reduction in OC levels in patients receiving glucocorticoid therapy 12,13 and in patients with endogenous hypercortisolism. [14][15][16] The resulting suppression of bone formation is so profound that OC levels were tested and shown to be effective in differentiating endogenous Cushing's syndrome (CS) from healthy control subjects with an area under the curve (AUC) of 0.922, which is similar to the late-night salivary cortisol (LNSC) of 0.994 obtained from a receiver operating characteristic (ROC) analysis in the same cohort of people. 17 However, the most challenging cases involve differentiating patients with endogenous CS from obese subjects due to similar clinical features and complications such as the presence of functional hypercortisolism with relatively higher cortisol levels in obese subjects compared with healthy controls.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic performance of osteocalcin measurements in patients with endogenous Cushing’s syndrome

Belaya¹,

Iljin²,

Мельниченко³

et al. 2016

BoneKEy Reports

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The aim of this study was to evaluate the diagnostic performance of osteocalcin (OC), as measured by automated electrochemiluminescence immunoassay (ECLIA), in identifying Cushing's syndrome (CS) in two separate populations: among obese and overweight subjects and among women of postmenopausal age with osteoporosis. Among the 106 referral patients with obesity, CS was confirmed in 42 cases. The patients of the referred population provided late-night salivary cortisol (LNSC), underwent low-dose dexamethasone suppression testing (DST) and were further evaluated until CS was pathologically confirmed. A threshold of OC-8.3 ng ml À 1 differentiated CS among obese and overweight subjects with a sensitivity of 73.8% (95% confidence interval (CI) 58.9-84.7) and a specificity of 96.9% (95% CI 89.3-99.1). The total area under the receiver operating characteristic curve (AUC) was 0.859 (95% CI 0.773-0.945), which was lower than LNSC or DST (P ¼ 0.01). In the retrospective portion of the study, the OC levels were evaluated in 67 subjects with newly diagnosed postmenopausal osteoporosis and in 23 patients (older than 45) with newly diagnosed CS and osteoporosis (presence of low traumatic fractures or T-score P-2.5). The diagnostic performance of OC for osteoporosis due to CS was within an AUC of 0.959 (95% CI 0.887-1.00). A threshold for OC of 8.3 ng ml-1 yielded a sensitivity of 95.4% (95% CI 78.2-99.2%) and a specificity of 98.5% (95% CI 92.0-99.7%). Thus, osteocalcin could be used in the diagnostic testing for endogenous hypercortisolism in patients referred to exclude CS and to identify CS among patients of postmenopausal age with osteoporosis.

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“…Due to increased protein catabolism and negative nitrogen balance, muscular atrophy, osteoporosis and fragility of connective tissue are often encountered. Levels of free fatty acids and cholesterol are increased in plasma, and a centripetal distribution of fatty tissue is characteristic [8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Cushing’s syndrome diagnosed after delivery: a case report

et al. 2013

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Bone turnover in patients with endogenous Cushing’s syndrome before and after successful treatment

Cited by 41 publications

References 27 publications

Bone resorption is suppressed immediately after the third and fourth days of multiday cycling but persistently increased following overnight recovery

Bone resorption is suppressed immediately after the third and fourth days of multiday cycling but persistently increased following overnight recovery

Diagnostic performance of osteocalcin measurements in patients with endogenous Cushing’s syndrome

Cushing’s syndrome diagnosed after delivery: a case report

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