Pheochromocytoma, paraganglioma underrecognized cause of secondary osteoporosis
Adults with pheochromocytoma or paraganglioma are nearly five times more likely to experience a vertebral fracture, a hallmark of osteoporosis, when compared with adults with nonfunctional adrenal tumors, according to findings published in Bone.
“Pheochromocytoma and paraganglioma are often associated with vertebral fracture,” Maki Yokomoto-Umakoshi, MD, PhD, an academic fellow in the department of endocrinology, metabolism and diabetes at Kyushu University Hospital, Japan, told Healio. “Most vertebral fractures in pheochromocytoma and paraganglioma are asymptomatic, and thus radiographs of the spine are recommended. Early detection and surgical treatment are required to prevent bone loss in pheochromocytoma and paraganglioma. However, aging increases the incidence of vertebral fracture, and bone mineral density may not be improved enough in older patients with pheochromocytoma and paraganglioma. Thus, long-term follow-up and medication for osteoporosis may be required in older patients with vertebral fracture, even if they undergo surgical resection.”
In a retrospective, cross-sectional study, Yokomoto-Umakoshi and colleagues analyzed data from 49 adults with pheochromocytoma and paraganglioma and 61 adults with nonfunctional adrenal tumors who underwent spine radiographs, and 23 adults with pheochromocytoma and paraganglioma who underwent BMD assessment via DXA at follow-up. Researchers evaluated the prevalence of vertebral fracture among adults with pheochromocytoma and paraganglioma and those with nonfunctional adrenal tumors. Researchers further evaluated BMD at baseline and after surgery among adults with pheochromocytoma and paraganglioma.
Researchers found that adults with pheochromocytoma and paraganglioma had a higher prevalence of vertebral fracture vs. those with nonfunctional adrenal tumors (43% vs. 16%; P = .002). Additionally, pheochromocytoma and paraganglioma were associated with vertebral fracture after adjusting for age and sex (OR = 4.47; 95% CI, 1.76-11.3).
In BMD analyses, adults with pheochromocytoma and paraganglioma experienced a mean 3.8% improvement at the lumbar spine between baseline (mean, 0.855 g/cm2) and follow-up measurement after surgery (mean, 0.888 g/cm2) for a mean difference of 0.032 g/cm2 (P = .026).
“The risk of vertebral fractures in pheochromocytoma and paraganglioma may be larger than that in postmenopausal females, of whom approximately 20% have prevalent vertebral fracture,” the researchers wrote. “Pheochromocytoma and paraganglioma also showed lower BMD at trabecular bone than nonfunctional adrenal tumors, which is consistent with previous reports. We also demonstrated that BMD at trabecular bone, which is one of the most standard methods to evaluate for bone strength, was improved after surgical resection of pheochromocytoma and paraganglioma. These observations, taken together, suggest that pheochromocytoma and paraganglioma [are] an important cause of secondary osteoporosis.” – by Regina Schaffer
For more information:
Maki Yokomoto-Umakoshi, MD, can be reached at the Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan; email: firstname.lastname@example.org.
Disclosures: The authors report no relevant financial disclosures.