6533b854fe1ef96bd12ae06a
RESEARCH PRODUCT
Treatment of skeletal impairment in patients with endogenous hypercortisolism: when and how?
A ScillitaniG MazziottiC Di SommaS MorettiA StiglianoR PivonelloA GiustinaA ColaoN AlbigerA AmbrogioG ArnaldiE ArvatR BaldelliR BerardelliM BoscaroSalvatore Cannavo'F CavagniniA ColaoSm CorselloA CozzolinoA De BartolomeisM De LeoG Di MinnoC Di SommaK EspositoG FabbrociniD FeroneC ForestaM GalderisiC GiordanoD GiuglianoA GiustinaF GrimaldiAm IsidoriE JanniniF LombardoL ManettiM MannelliF ManteroG MaroneG MazziottiS MorettiE NazzariRm ParagliolaR PasqualiS PecorelliF Pecori GiraldiC PivonelloR PivonelloG ReimondoC ScaroniA ScillitaniC SimeoliA StiglianoV ToscanoL TrementinoG VitaleM. C. Zatellisubject
Oncologymedicine.medical_specialtyFRAXEndocrinology Diabetes and MetabolismOsteoporosisHypercortisolismAdrenal incidentaloma; Cushing's disease; Glucocorticoids; Osteoporosis; Bone Density Conservation Agents; Cushing Syndrome; Glucocorticoids; Humans; Osteoporosis; Osteoporotic Fractures; Risk FactorsEndogenyDiseaseadrenal incidentalomaBone remodelingRisk FactorsInternal medicinemedicineHumansCushing SyndromeBone Density Conservation Agentsglucocorticoidsbusiness.industrycushing's diseaseCushing's diseasemedicine.diseaseosteoporosisRheumatologyglucocorticoids; osteoporosis; cushing's disease; adrenal incidentalomaEndocrinologyAdrenal incidentaloma; CUSHING'S DISEASE; Glucocorticoids; OsteoporosisbusinessGlucocorticoidOsteoporotic Fracturesmedicine.drugdescription
Guidelines for the management of osteoporosis induced by endogenous hypercortisolism are not available. Both the American College of Rheumatology and the International Osteoporosis Foundation recommend to modulate the treatment of exogenous glucocorticoid-induced osteoporosis (GIO) based on the individual fracture risk profile (calculated by FRAX) and dose of glucocorticoid used, but it is difficult to translate corticosteroid dosages to different degrees of endogenous hypercortisolism, and there are no data on validation of FRAX stratification method in patients with endogenous hypercortisolism. Consequently, it is unclear whether such recommendations may be adapted to patients with endogenous hypercortisolism. Moreover, patients with exogenous GIO take glucocorticoids since suffering a disease that commonly affects bone. On the other hand, the correction of coexistent risk factors, which may contribute to increase the fracture risk in patients exposed to glucocorticoid excess, and the removal of the cause of endogenous hypercortisolism, may lead to the recovery of bone health. Although the correction of hypercortisolism and of possible coexistent risk factors is necessary to favor the normalization of bone turnover with recovery of bone mass; in some patients, the fracture risk could not be normalized and specific anti-osteoporotic drugs should be given. Who, when, and how the patient with endogenous hypercortisolism should be treated with bone-active therapy is discussed.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2014-01-01 |