Subclinical Hypercortisolism among Outpatients Referred for Osteoporosis

Abstract

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

Bone quality, as measured by trabecular bone score in patients with adrenal incidentalomas with and without subclinical hypercortisolism

“…However, this limit has been overcome, at least in part, by the longitudinal arm that confirms the role of TBS in predicting vertebral fractures in AI patients. In addition, although no intervention studies are available on the effect on bone tissue of the recovery from SH, (2) the idea that SH exerts a negative effect on bone is reinforced by literature data showing that SH is more prevalent in patients with osteoporosis (34) and by the fact that patients with SH have an increased rate of bone loss. (7) A possible limit of the study could be related to the condition of SH per se.…”

“…Although in some patients the diagnosis of SH may be questionable, the diagnostic criteria we used in the present study are generally accepted, because they have been validated clinically. (2,36) Moreover, it must be considered that the condition of hypercortisolism, which is more prevalent in patients with osteoporosis, (34) and is known to affect both bone density and quality, is one of the most interesting models to evaluate the techniques assessing bone microarchitecture. The condition of endogenous SH has the advantage that, at variance with the exogenous cortisol excess, it avoids the negative effects on bone of the diseases for which glucocorticoids are given.…”

Associations Between Positive and Negative Affect and 12-Month Physical Disorders in a National Sample

“…For example, traditional models of stress and stress adaptation, particularly that of Selye (1976), suggest that the cumulative ''wear and tear'' associated with emotional distress may eventually trigger allostatic mechanisms that increase the risk of illness and disease. Indeed, allostatic changes associated with enduring hypothalamic-pituitary-adrenal axis activation and concomitant elevations in cortisol Clin Psychol Med Settings (2012) 19:197-210 205 secretion include detrimental immunological processes, such as immunosuppression or excessive levels of proinflammatory cytokines (e.g., IL-6) (Robles, Glaser, & Kiecolt-Glaser, 2005), as well as increased risks of cardiovascular diseases (al'Absi & Wittmers, 2003;Flipovsky, Ducimetaere, Eschwaege, Richard, Rosselin, & Claude, 1996), diabetes (Korenblum et al, 2005;Roy, Roy, & Brown, 1998), osteoporosis (Chiodini et al, 2007), peptic ulcers (Lechin et al, 1990), and autoimmune diseases (Straub et al, 2004). As negative affect is considered to subsume negative emotions, such as depression (Watson & Clark, 1984;Watson, Clark, & Carey, 1988;Watson, Clark, & Tellegen, 1988), and increased secretion of cortisol is one of the best documented biological correlates of depression, it is perhaps not coincidental that the prevalence of the disorders mentioned previously is high among people with depression (Evans et al, 2005;Sherwood Brown, Varghese, & McEwen, 2004).…”

Recommendations of the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism for the diagnosis of Cushing’s disease in Brazil

“…In contrast, patients suffering from Cushing's syndrome due to EAS, particularly those with malignancies However, several studies have been devoted to investigating hypercortisolism in groups of patients considered at risk or in whom the prevalence of Cushing's syndrome may be greater than expected. The at-risk conditions often highlighted are secondary hypertension, in which the prevalence of Cushing's syndrome has been reported to be approximately 0.5-1% of cases, adrenal incidentalomas (6-9%) and unexplained osteoporosis with vertebral fracture (11%) (32,33).…”