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上腺瘤患者因皮质醇过量状态造成骨折风险:基于人口的队列研究
Annette L Adams1,2, In-Lu Amy Liu1, Iris Anne C Reyes1
1Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave, 2nd Floor, Pasadena, CA 91101, United States.
JBMR plus
|April 29, 2025
概括
患有上腺意外瘤 (AIs) 的患者可能因皮质醇过量而面临骨折风险增加. 这项研究表明了潜在的联系,虽然在统计学上并不显著,但强调了需要更好地识别激素活性AI.
科学领域:
- 内分泌学 在内分泌学.
- 骨的新陈代谢 骨的新陈代谢
- 老年医学 老年医学
背景情况:
- 上腺意外瘤 (AIs) 可以高分泌皮质醇,导致过度暴露于葡萄糖皮质激素.
- 这种过量的皮质醇可能会降低骨矿物质密度,增加骨折风险.
- 在AI患者中,皮质醇过量往往无法测量,导致骨折风险的诊断不足.
研究的目的:
- 调查过多的皮质醇水平与AI患者的脆弱性骨折发生率之间的关联.
- 为了确定患有AI和亚临床皮质醇过剩的患者是否有更高的骨折风险.
主要方法:
- 对14886名患有AI的50岁以上患者进行了回顾性队列研究 (2015-2022年).
- 基于德甲抑制试验 (DST) 和尿液/血清皮质醇水平的皮质醇过量状态的分类.
- 使用考克斯的比例危险模型分析骨折发生率,对共变量进行调整,并将死亡率视为竞争风险.
主要成果:
- 1.8%的患者通过DST确认了自主皮质醇分泌 (ACS);1.4%的患者从其他测试中显示了有意义的结果.
- 62.8%的患者没有接受过多的皮质醇检测.
- 患有ACS,暗示皮质醇过量或未经测试的病情的患者表现出增加骨折风险的趋势 (HR分别为1.42,1.41和1.28),但这些并没有达到统计学意义.
结论:
- 虽然趋势表明上腺瘤和皮质醇过量患者的骨折风险较高,但这些发现在统计学上并不显著.
- 在未经测试的患者中观察到的高风险可能表明大量未被诊断的,荷尔蒙活性AI有助于二次骨质疏松症.
- 需要进一步的研究来证实这些关联,并改善AI管理中皮质醇过剩的诊断策略.
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