Endocrine Abstracts

High dose and long-term glucocorticoid (GC) therapy reduce bone mass and negatively affect the metabolic profile. Patients in remission after successful treatment of Cushing’s syndrome (CS) often present hypoadrenalism and require long-term GC replacement.

Objective: To evaluate the effect of GC therapy on bone and metabolic parameters in women after long-term remission of CS. Materials and methods: Thirty-two women (mean age: 50±14 years) with cured CS were enrolled. Mean time of cure was 11±6 years. Twenty-three patients had pituitary and 9 adrenal tumours. Bone mineral density (BMD) and body composition was measured by dual-energy x-ray absorptiometry scanning (DEXA). Anthropometric and laboratory parameters were measured (lipid profile, adiponectin, glucose, insulin, serum calcium, alkaline phosphate, fibrinogen, IGF-I and free T4). Duration of GC treatment, GC dose, and duration of hypercortisolism (including duration of CS symptoms pre-diagnosis and from diagnosis until cure) were calculated. Results were compared with those of 25 age-matched control women. Results: Duration of GC treatment, GC dose and duration of hypercortisolism were negatively correlated with bone mineral content (BMC) and BMD, and positively with fibrinogen. After multiple linear regression analysis, duration of GC treatment (P=0.003) and current age (P=0.019) were significantly related to BMC; only duration of GC treatment was related to BMD (P=0.002); whereas duration of hypercortisolism was significantly related to fibrinogen (P=0.004) and insulin (P=0.015). Daily GC dose was related to adiponectin (P=0.012). Patients treated longest with GC therapy (>24 months) had less BMC (P=0.002) and BMD (P=0.001) than those treated for <24 months and controls.

Conclusions: ‘Replacement’ therapy with GC in women in remission after successful therapy for CS who are adrenal insufficient, is correlated with a reduction in bone mass and adiponectin. Thus, GC should be prescribed in the lowest dose and shortest time possible.

Supported by FIS 05/0448and CIBER 06 07/044.