High Prevalence of Radiological Vertebral Fractures in Patients With TSH-Secreting Pituitary Adenoma

Abstract

BackgroundBone loss and high risk of fractures have been reported in patients with primary hyperthyroidism, whereas data on skeletal health in TSH-secreting adenoma (TSH-oma) are scant, and the risk of fractures in this specific clinical context has not been investigated so far. In this cross-sectional study, we aimed at evaluating for the first time, to our knowledge, the prevalence and determinants of radiological vertebral fractures (VFs) in patients with TSH-oma.MethodsTwenty-two patients (10 males, 12 females; median age 47 years) with TSH-oma and 44 patients (20 males, 24 females; median age 49 years) with nonfunctioning pituitary adenoma (NFPA) were retrospectively evaluated for thoracic VFs using a morphometric approach on lateral chest X-ray routinely performed in the presurgical diagnostic workup.ResultsThe prevalence of VFs was significantly higher in TSH-oma vs NFPA (59.1% vs 22.7%; P = 0.003), the difference being still significant (odds ratio, 10.5; P = 0.005) after correction for the size of pituitary adenomas and biochemical parameters. In TSH-oma, the prevalence of VFs was significantly associated with older age (P = 0.007) and higher serum free T4 values (P = 0.02). In 20 patients, data on presurgical medical therapies of TSH-oma were available. All patients not treated with somatostatin receptor ligands were fractured compared with 25% of those who were treated with these drugs (P = 0.001). No significant (P = 0.25) association between VFs and treatment with methimazole was found.ConclusionsThis study provides the first evidence, to our knowledge, that patients with TSH-oma may develop VFs in close relationship with severity of hyperthyroidism.

Radiological Thoracic Vertebral Fractures are Highly Prevalent in COVID-19 and Predict Disease Outcomes

“…Thoracic VFs were detected on lateral chest x-rays using a qualitative and semiquantitative assessment and evaluation of vertebral shape ( 21 , 22 ). Using a translucent digitizer and a cursor, 6 points were marked on each vertebral body to describe vertebral shape.…”

“…Since only about one-third of VFs are actually clinically diagnosed using the historical (anamnestic questionnaire-based) approach, radiological and morphometric approaches have emerged as the gold standard to assess the true prevalence and incidence of VFs in the general population and high-risk patients ( 20 , 21 ). Interestingly, morphometric VFs can be detected also on lateral chest x-rays ( 21 , 22 ).…”

COVID-19 and the pituitary

“…Interestingly, patients with a wide range of pituitary diseases were consistently reported in the last two decades to be burdened by a very high prevalence of morphometric VFs [ 36 ]. Specifically, prevalent VFs were found in one third to half of patients with acromegaly [ 37 ], Cushing disease [ 38 ], TSH-secreting adenomas [ 39 ] and hypopituitarism [ 40 ] equally in both sexes. Moreover, in acromegaly and hypopituitarism an increased incidence of VFs was also reported [ 41 , 42 ].…”

Hypovitaminosis D and the endocrine phenotype of COVID-19

“…Briefly, thoracic VFs [ 25 ] at hospital admission were detected in 41 of 114 patients (36%) and were prevalently mild but in 41% of the cases moderate or severe [ 26 ]. Age was significantly associated with VFs in multivariate analysis.…”