Bone resorption is increased in pheochromocytoma patients and normalizes following adrenalectomy

AG Veldhuis-Vlug, M El Mahdiui… - The Journal of …, 2012 - academic.oup.com
AG Veldhuis-Vlug, M El Mahdiui, E Endert, AC Heijboer, E Fliers, PH Bisschop
The Journal of Clinical Endocrinology & Metabolism, 2012academic.oup.com
Context: The sympathetic nervous system (SNS) controls bone turnover in rodents, but it is
uncertain whether a similar role for the SNS exists in humans. Pheochromocytomas are
catecholamine-producing neuroendocrine tumors. Because catecholamines are the
neurotransmitters of the SNS, we hypothesized that pheochromocytoma patients have
increased bone turnover. Objective: Our objective was to compare bone turnover in
pheochromocytoma patients and controls. Design and Setting: This retrospective case …
Context
The sympathetic nervous system (SNS) controls bone turnover in rodents, but it is uncertain whether a similar role for the SNS exists in humans. Pheochromocytomas are catecholamine-producing neuroendocrine tumors. Because catecholamines are the neurotransmitters of the SNS, we hypothesized that pheochromocytoma patients have increased bone turnover.
Objective
Our objective was to compare bone turnover in pheochromocytoma patients and controls.
Design and Setting
This retrospective case-control study was performed at the Endocrine Department of the Academic Medical Center of the University of Amsterdam in The Netherlands from 2007 until 2011.
Patients
All patients were screened for pheochromocytoma. Cases (n = 21) were identified by 24-h urinary excretion of fractionated metanephrines above the institutional reference value and confirmed by histology after adrenalectomy. All patients screened and diagnosed as not having pheochromocytoma served as controls (n = 126).
Main Outcome Measure
The difference in bone turnover markers C-terminal cross-linking telopeptides of collagen type I (CTx) and procollagen type 1 N propeptide (P1NP) between cases and controls was the main outcome measure.
Results
CTx concentrations were higher in cases [343 ng/liter; interquartile range (IQR), 295 ng/liter] than in controls (232 ng/liter; IQR, 168 ng/liter; P < 0.001) and decreased after adrenalectomy [before, 365 ng/liter (IQR, 450 ng/liter); after, 290 ng/liter (IQR, 241 ng/liter); P = 0.044]. The effect remained after adjustment for possible confounders. P1NP concentrations did not differ.
Conclusions
This study shows that pheochromocytoma patients have increased bone resorption, which normalizes after adrenalectomy. This finding supports the concept of regulation of bone remodeling by the SNS in humans.
Oxford University Press