Endocrine Abstracts

This study estimates the recovery of bone mineral density (BMD), markers of bone remodeling and quality of life in patients with endogenous Cushing’s syndrome (CS) after 12 months of remission.

Materials and methods: Twenty-one patients with CS were prospectively evaluated at active stage of the disease and after being in a full remission (substitutional therapy with hydrocortisone or normal 24 h urinary free cortisol (24 h UFC) and late-night cortisol) during 12 months. A thoracic and lumbar X-ray was performed to reveal vertebral fractures. BMD was measured by DXA (Lunar). Markers of bone remodeling were assayed by ECLIA Cobas e601 Roche. Patients fulfilled EQ-5D, ECOS-16 questionnaires and performed ‘up-and-go’, ‘tandem’, and ‘chair-rising’ tests.

Results: Among enrolled patients 17 were females; four males; median of age (Q25–Q75) – 41 (33–49) years old; in ten cases (48%) low traumatic fractures were diagnosed. After the achieving remission no new fractures were registered and significant improvement in Z-score was revealed: L1–L4 −1.8 (−2.6 to −0.5) vs −1.2 (−2.2 to −0.5) (P=0.05); Neck Z-score −0.9 (−1.7 to −0.8) vs −0.7 (−1.6 to −0.3), P=0.003. Osteocalcin increased from 8.2 (6.9–12.0) to 22.7 (12.1–36.5) ng/ml, P=0.01 and carboxyterminal cross-linked telopeptide of type I collagen from 0.35 (0.22–0.63) to 0.7 (0.28–1.05) ng/ml, P=0.01. The quality of life significantly improved at all dimensions if measured by ECOS-16. According to the EQ-5D patients suffered less from pain 1.35 (0.49) vs 1.12 (0.34), P=0.04 and reported the improvement in their health (visual analogue scale) from 49 (18.9)–68 (10.9), P=0.004, but did not differ in others dimensions. Although 100% of patients admitted the improvement in their functional ability, the difference in functional tests did not reach statistical significance.

Conclusions: Achieving remission of CS during 12 months improves BMD and quality of life in patients with CS. However, longer time is needed for a full recovery.