Endocrine Abstracts

JOINT3470

Introduction: Cushing’s syndrome is a very rare disorder characterised by a variety of clinical manifestations that result from cortisol excess, which can lead to multiple comorbidities such as diabetes mellitus, hypertension and bone disease. Prospective studies on large groups of patients with endogenous hypercortisolaemia assessing calcium-phosphate and bone metabolism over time are scarce. The aim To evaluate the effect of hypercortisolaemia treatment on bone metabolism and structure in patients with endogenous Cushing’s syndrome.

Patients and Methods: This is a controlled, prospective single-centre study involving a total of 30 consecutive patients diagnosed with endogenous Cushing’s syndrome hospitalised at the Department of Endocrinology at Bielański Hospital in Warsaw. We evaluated patients’ medical records, hormonal results (with special emphasis on calcium-phosphate and bone metabolism) at diagnosis and after implementation of surgical or pharmacological treatment. Bone turnover markers such as sclerostin, DKK-1, CTx, PINP will be assessed before and 3, 6, 12 months after achievement of normocortisolemia. A control group was matched based on sex, age and BMI, excluding hypercortisolemia.

Results: To date, we have enrolled 10 patients with endogenous Cushing’s syndrome Male gender was predominant (M:F=7:3). The mean age at diagnosis was 47.9 ± 16.6 years and ranged from 27 to 64 years. Nine out of 10 patients were diagnosed with ACTH-dependent hypercortisolemia (Cushing’s disease). Average cortisol concentration at the diagnosis was 22.17 mg/dL. At follow-up at 3 months after achieving normocortisolemia, calcium-phosphate metabolism tests showed increase in total serum calcium (2.46\.\..2.53mmol/l), phosphorus (1.13\.\.1.45mmol/l) and decrease in calciuria (4.78\.\.3.64mmol/24h) and phosphaturia (23.18\.\. 16.95mmol/24h). There was a decrease in parathormone concentration (36,5…. 26,45pg/ml) and the active form of vitamin D [1,25(Oh2)D] (48,42……\.35,92pg/ml). At baseline, mean bone mineral density was reduced L1-L4 T-score: -1.53 SD, femoral neck T-score: -1.28 SD, TBS T-score: -1.48 SD. The mean sclerostin concentration at the time of diagnosis of hypercortisolemia was 62,94 ng/ml, while Dkk-1 was 5078 ng/ml.

Conclusions: Our results confirmed that normocortisolemia improved calcium-phosphate metabolism. Further conclusions regarding changes in calcium-phosphate levels and bone turnover markers over time in normocortisolemic patients can be drawn when a larger study group has been enrolled.