Lower Bone Mass and Higher Bone Resorption in Pheochromocytoma: Importance of Sympathetic Activity on Human Bone

• Published in: The journal of clinical endocrinology and metabolism 2017-08, Vol.102 (8), p.2711-2718
• Main Authors: Kim, Beom-Jun, Kwak, Mi Kyung, Ahn, Seong Hee, Kim, Hyeonmok, Lee, Seung Hun, Song, Kee-Ho, Suh, Sunghwan, Kim, Jae Hyeon, Koh, Jung-Min
• Format: Article
• Language: English
• Subjects: Adrenal Gland Neoplasms - epidemiology; Adrenal Gland Neoplasms - metabolism; Adrenal Gland Neoplasms - surgery; Adrenalectomy; Adult; Aged; Alkaline phosphatase; Alkaline Phosphatase - metabolism; Bone Density; Bone Diseases, Metabolic - diagnostic imaging; Bone Diseases, Metabolic - epidemiology; Bone Diseases, Metabolic - metabolism; Bone loss; Bone mass; Bone mineral density; Bone resorption; Bone Resorption - diagnostic imaging; Bone Resorption - epidemiology; Bone Resorption - metabolism; Bone turnover; Cancellous bone; Case-Control Studies; Catecholamine; Catecholamines; Chromatography; Collagen; Collagen Type I - metabolism; Confidence intervals; Endocrinology; Female; Femur; Femur Neck - diagnostic imaging; Fractures; Hip; Humans; Lumbar Vertebrae - diagnostic imaging; Male; Medicine; Metabolism; Middle Aged; Neck; Nervous system; Neuroendocrine tumors; Odds Ratio; Osteoporosis; Peptides - metabolism; Pheochromocytoma; Pheochromocytoma - epidemiology; Pheochromocytoma - metabolism; Pheochromocytoma - surgery; Phosphatase; Rodents; Side effects; Skeleton; Spine; Spine (lumbar); Standard deviation; Sympathetic Nervous System; Womens health
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/jc.2017-00169

Abstract Context Despite the apparent biological importance of sympathetic activity on bone metabolism in rodents, its role in humans remains questionable. Objective To clarify the link between the sympathetic nervous system and the skeleton in humans. Design, Setting, and Patients Among 620 consecutive subjects with newly diagnosed adrenal incidentaloma, 31 patients with histologically confirmed pheochromocytoma (a catecholamine-secreting neuroendocrine tumor) and 280 patients with nonfunctional adrenal incidentaloma were defined as cases and controls, respectively. Results After adjustment for confounders, subjects with pheochromocytoma had 7.2% lower bone mass at the lumbar spine and 33.5% higher serum C-terminal telopeptide of type 1 collagen (CTX) than those without pheochromocytoma (P = 0.016 and 0.001, respectively), whereas there were no statistical differences between groups in bone mineral density (BMD) at the femur neck and total hip and in serum bone-specific alkaline phosphatase (BSALP) level. The odds ratio (OR) for lower BMD at the lumbar spine in the presence of pheochromocytoma was 3.31 (95% confidence interval, 1.23 to 8.56). However, the ORs for lower BMD at the femur neck and total hip did not differ according to the presence of pheochromocytoma. Serum CTX level decreased by 35.2% after adrenalectomy in patients with pheochromocytoma, whereas serum BSALP level did not change significantly. Conclusions This study provides clinical evidence showing that sympathetic overstimulation in pheochromocytoma can contribute to adverse effects on human bone through the increase of bone loss (especially in trabecular bone), as well as bone resorption. This study provides clinical evidence showing that sympathetic overstimulation can contribute to adverse effects on human bone through the increase of bone loss, as well as bone resorption.