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Abstract：
Morphometric vertebral fractures (VFs) and osteopathy are prevalent and clinically significant complications of Cushing disease (CD). However whether they represent an early occurrence in the natural progression of the disease is an ongoing debate. This study aimed to assess the prevalence and determinants of VFs in patients newly diagnosed with CD.
This cross-sectional case-control study recruited 75 newly diagnosed CD patients and compared them with a control group of individuals without pituitary disorders or secondary forms of osteoporosis. Demographic, clinical and biochemical data were collected. The VFs were assessed using preoperative lateral chest radiography.
We found a significantly higher prevalence of VFs in the CD group than in the control group (58.7% vs. 14.5%; P < 0.001). Among the CD patients with VFs, 27 (61.4%) showed moderate/severe VFs. The CD patients with VFs had significantly higher preoperative 8 am serum cortisol (8ASC) levels than those without VFs (P < 0.001). The preoperative 4 pm adrenocorticotropic hormone (ACTH) levels (P = 0.031), preoperative 0 am ACTH levels (P = 0.021) and systolic blood pressure were slightly higher in CD patients with VFs than in those without VFs (P = 0.028). A binary multiple logistic analysis showed that 8ASC was an independent predictor of VF risk (P = 0.003). The optimal cut-off value of the preoperative serum 8ASC level for predicting VFs was 22.18 ng/mL.
This is the first study reporting a high prevalence of radiologic VFs in recently diagnosed CD patients. VFs may represent an early manifestation of CD and may be related to cortisol levels. Therefore, VF assessment should be included in the workup during CD diagnosis.
This cross-sectional case-control study recruited 75 newly diagnosed CD patients and compared them with a control group of individuals without pituitary disorders or secondary forms of osteoporosis. Demographic, clinical and biochemical data were collected. The VFs were assessed using preoperative lateral chest radiography.
We found a significantly higher prevalence of VFs in the CD group than in the control group (58.7% vs. 14.5%; P < 0.001). Among the CD patients with VFs, 27 (61.4%) showed moderate/severe VFs. The CD patients with VFs had significantly higher preoperative 8 am serum cortisol (8ASC) levels than those without VFs (P < 0.001). The preoperative 4 pm adrenocorticotropic hormone (ACTH) levels (P = 0.031), preoperative 0 am ACTH levels (P = 0.021) and systolic blood pressure were slightly higher in CD patients with VFs than in those without VFs (P = 0.028). A binary multiple logistic analysis showed that 8ASC was an independent predictor of VF risk (P = 0.003). The optimal cut-off value of the preoperative serum 8ASC level for predicting VFs was 22.18 ng/mL.
This is the first study reporting a high prevalence of radiologic VFs in recently diagnosed CD patients. VFs may represent an early manifestation of CD and may be related to cortisol levels. Therefore, VF assessment should be included in the workup during CD diagnosis.
摘要：
■形态测量椎体骨折（VFs）和骨病是库欣病（CD）的普遍存在且具有临床意义的并发症。然而，它们是否代表疾病自然进展的早期发生是一个持续的争论。这项研究旨在评估新诊断为CD的患者中VFs的患病率和决定因素。
■这项横断面病例对照研究招募了75名新诊断的CD患者，并将他们与没有垂体疾病或继发性骨质疏松症的对照组进行了比较。人口统计,收集临床和生化数据。使用术前外侧胸部X线照相术评估VFs。
■我们发现CD组中VF的患病率明显高于对照组（58.7％vs.14.5%;P<0.001)。在患有VFs的CD患者中，27例（61.4%）显示中度/重度VF。有VFs的CD患者术前8am血清皮质醇（8ASC）水平明显高于无VFs的患者（P<0.001）。术前下午4时促肾上腺皮质激素(ACTH)水平(P=0.031),有VFs的CD患者术前0amACTH水平（P=0.021）和收缩压略高于无VFs的患者（P=0.028）。二元多元logistic分析显示8ASC是VF风险的独立预测因子(P=0.003)。术前血清8ASC水平预测VFs的最佳临界值为22.18ng/mL。
■这是首次报告在最近诊断的CD患者中放射学VFs的高患病率的研究。VFs可能代表CD的早期表现，可能与皮质醇水平有关。因此,在CD诊断期间的检查中应包括VF评估。
■这项横断面病例对照研究招募了75名新诊断的CD患者，并将他们与没有垂体疾病或继发性骨质疏松症的对照组进行了比较。人口统计,收集临床和生化数据。使用术前外侧胸部X线照相术评估VFs。
■我们发现CD组中VF的患病率明显高于对照组（58.7％vs.14.5%;P<0.001)。在患有VFs的CD患者中，27例（61.4%）显示中度/重度VF。有VFs的CD患者术前8am血清皮质醇（8ASC）水平明显高于无VFs的患者（P<0.001）。术前下午4时促肾上腺皮质激素(ACTH)水平(P=0.031),有VFs的CD患者术前0amACTH水平（P=0.021）和收缩压略高于无VFs的患者（P=0.028）。二元多元logistic分析显示8ASC是VF风险的独立预测因子(P=0.003)。术前血清8ASC水平预测VFs的最佳临界值为22.18ng/mL。
■这是首次报告在最近诊断的CD患者中放射学VFs的高患病率的研究。VFs可能代表CD的早期表现，可能与皮质醇水平有关。因此,在CD诊断期间的检查中应包括VF评估。
