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Urinary free cortisol excretion is associated with lumbar bone density in patients with adrenal Cushing’s syndrome

Hypertension Research volume 45, pages 1632–1642 (2022)Cite this article

A Correction to this article was published on 12 August 2022

This article has been updated

Abstract

Patients with adrenal Cushing’s syndrome have a poor prognosis due to the autonomous hypersecretion of endogenous cortisol from the adrenal gland. Although several clinical examinations have been developed to manifest the autonomous hypersecretion of endogenous cortisol in this syndrome, it is unknown which parameter of cortisol overproduction is best associated with the adrenal cortisol content and bone and vascular complications of this syndrome. Therefore, the present study was undertaken to evaluate the parameter(s) associated with the adrenal cortisol content in patients with adrenal Cushing’s syndrome, as well as to assess the associations between these parameters and the vascular and bone complications of this syndrome. Cardiovascular factors such as blood pressure and pulse rate, glucose metabolism, lipid metabolism, renal function, and indices of arteriosclerosis, except for diastolic blood pressure, failed to show an association with the adrenal cortisol content. Twenty-four-hour urinary free cortisol excretion (ρ = 0.893, P = 0.007) and plasma cortisol levels after the 1-mg (ρ = 0.857, P = 0.014) or 8-mg (ρ = 0.900, P = 0.037) overnight dexamethasone suppression test, but not plasma cortisol levels in the morning or late at night or indices of 131I-adosterol single-photon emission computed tomography-computed tomography, were significantly and positively associated with the adrenal cortisol content. Twenty-four-hour urinary free cortisol excretion, and not plasma cortisol levels after the 1- or 8-mg overnight dexamethasone suppression test, was significantly and negatively associated with lumbar spine bone density (lumbar spine bone mineral density, ρ = −0.786, P = 0.036; lumbar spine T score, ρ = −0.883, P = 0.009; and lumbar spine Z score, ρ = −0.883, P = 0.009). These results indicate that 24-h urinary free cortisol excretion is best associated with a decrease in bone density via increased adrenal cortisol overproduction and suggest that it could be used as a marker for osteoporosis in these patients.

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Acknowledgements

We thank Noriko Morishima for her technical support with the measurement of cortisol concentrations in the adrenal tumors and Asanuma Masayasu and Youko Kizuka for their technical support with the 131I-adosterol SPECT/CT analysis.

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Authors and Affiliations

  1. Department of Endocrinology and Hypertension, Tokyo Women’s Medical University, Tokyo, Japan

    Miwa Kimura Takiguchi, Satoshi Morimoto, Daisuke Watanabe & Atsuhiro Ichihara

  2. Department of Radiology, Tokyo Medical University, Tokyo, Japan

    Koichiro Abe

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  1. Miwa Kimura Takiguchi
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  2. Satoshi Morimoto
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Correspondence to Satoshi Morimoto.

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The original online version of this article was revised: The original version of this article Contained errors in Table 2. In it, several numbers were incorrectly given in columns corresponding to the Endocrinological examination.

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Kimura Takiguchi, M., Morimoto, S., Watanabe, D. et al. Urinary free cortisol excretion is associated with lumbar bone density in patients with adrenal Cushing’s syndrome. Hypertens Res 45, 1632–1642 (2022). https://doi.org/10.1038/s41440-022-00939-8

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