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A Novel Method: Super-selective Adrenal Venous Sampling
Published on: September 15, 2017
Skeletal Microstructure in Addison's Disease
Leonardo Bandeira1,2, Rodrigo Nolasco Dos Santos1, Gustavo de Paula Ripka1
1Division of Endocrinology, Department of Medicine, Universidade Federal de Sao Paulo, Sao Paulo 04077-020, Brazil.
Context:
Addison's disease (AD) is characterized by deficient adrenal glucocorticoid (GC) production. Treatment involves just GC replacement, but patients often receive high doses, leading to side effects. Bone mineral density (BMD) data in AD are conflicting. High-resolution peripheral quantitative computed tomography (HRpQCT) evaluates volumetric BMD, microarchitecture, and mechanical properties of the tibia and radius. No studies have assessed bone quality by HRpQCT on subjects with AD.
Objective:
Evaluate the bone health of patients with AD using HRpQCT.
Design:
Cross-sectional study.
Setting:
Ambulatory of a tertiary medical center.
Participants:
Nineteen patients with AD on GC were compared to 38 matched controls.
Main Outcome Measures:
Dual-energy x-ray absorptiometry and HRpQCT measurements.
Results:
Patients with AD had lower lean mass and BMD. At the radius, the AD group had 11% lower trabecular (Tb) number (P = .03). At the tibia, patients had lower Tb number and Tb volumetric BMD, greater Tb separation, and lower cortical area and thickness (17-26% difference in these parameters, P < .03 for all). Tibial stiffness was 21% lower in the AD group (P < .03). In this group, there was a positive correlation between lean mass and stiffness (radius r = 0.53, tibia r = 0.51; both P < .04) and a negative correlation between cumulative GC dose and spine BMD (r = -0.67, P < .01).
Conclusion:
This is the first study to assess bone using HRpQCT in patients with AD on GC. Our findings suggest that AD patients have a loss of lean mass and skeletal fragility, mainly of the trabecular compartment and at the tibia. Bone loss may be related to loss of lean mass and GC.
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