Hormones synthesized by the adrenal reticulum protect bone density in premenopausal women with Cushing syndrome.

Background: Differences in bone metabolism between patients with adrenal Cushing's syndrome (ACS) and Cushing's disease (CD) have been noted, but the impact of steroid hormones on bone metabolism remains underexplored. The purpose of this study is to explore the differences in bone metabolism between the two subtypes of Cushing's syndrome and the correlation between hormones synthesized by the adrenal reticulum and bone metabolism.

Method: This retrospective study included 75 premenopausal women, consisting of 33 patients with CD and 42 patients with ACS. The clinical characteristics, laboratory examination and bone metabolism differences between the two groups were analyzed. Then, 16 patients with ACS and 12 patients with CD underwent comparison of blood steroid hormone levels. Additionally, the relationship between bone mineral density (BMD) values and steroid hormone variables was analyzed.

Results: The serum and urinary cortisol and serum ACTH concentrations were significantly higher in patients with CD compared to those with ACS. Conversely, lumbar and femoral BMD were lower, and osteocalcin (OC) levels were elevated in the ACS group. Dehydroepiandrosterone (DHEA) and dehydroepiandrosterone-sulphate (DHEAS) had a significant positive correlation with Z-score in lumbar spine in both CD and ACS group. However, Z-score in femoral neck had a significant positive correlation with DHEA and DHEAS only in the ACS group.

Conclusion: Bone loss is more pronounced in ACS than in CD, despite higher cortisol levels in CD patients. High levels of hormones synthesized by the adrenal reticulum might be protective for bone density in premenopausal women with hypercortisolism.