Metformin and Bone Metabolism in Endogenous Glucocorticoid Excess: An Exploratory Study.
Metformin and Bone Metabolism in Endogenous Glucocorticoid Excess: An Exploratory Study.
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内源性糖皮质激素过多状态下二甲双胍与骨代谢的探索性研究
DOI：
10.3389/fendo.2021.765067
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发表时间：
2021
影响因子：
5.2
通讯作者：
Reincke M
中科院分区：
文献类型：
--
作者：
Vogel F;Braun L;Rubinstein G;Zopp S;Oßwald A;Schilbach K;Schmidmaier R;Bidlingmaier M;Reincke M
糖皮质激素过量表现出其分解代谢特性的多种有害影响。二甲双胍最近被认为可以预防糖皮质激素治疗的不良代谢副作用。二甲双胍对内源性糖皮质激素过多的患者是否有益尚不清楚。目的：评价内源性库欣综合征(CS)患者确诊时应用二甲双胍治疗后的表型。作为德国库欣登记的一部分，我们从96名患者的预期队列中选择了所有10名在诊断时曾接受二甲双胍治疗(CS-MET)的患者。这10名患者在年龄、性别和体重指数方面与16名未接受二甲双胍治疗(CS-NOMET)的患者匹配。所有患者在诊断时都有面色鲜艳的CS。我们分析了身体成分、代谢参数、骨密度和骨重建标记物、肌肉功能和生活质量。正如预期的那样，糖尿病在CS-MET组中更普遍，HbA1c更高。在合并症和皮质醇亢进程度方面，两组具有可比性。我们没有观察到在肌肉功能或身体成分方面的差异。相比之下，在诊断时，接受二甲双胍治疗的患者的骨密度优于CS-NOMET组(中位数T-Score-0.8vs-1.4，p=0.030)。CS-MET患者在基线时β-CTx水平降低(p=0.041)，这表明在糖皮质激素过量期间，二甲双胍治疗减少了骨吸收。这项回顾性队列研究支持二甲双胍对内源性糖皮质激素过剩患者的潜在保护作用，特别是对骨代谢的保护作用。
Glucocorticoid excess exhibits multiple detrimental effects by its catabolic properties. Metformin was recently suggested to protect from adverse metabolic side-effects of glucocorticoid treatment. Whether metformin is beneficial in patients with endogenous glucocorticoid excess has not been clarified. To evaluate the phenotype in patients with endogenous Cushing’s syndrome (CS) treated with metformin at the time of diagnosis. As part of the German Cushing’s Registry we selected from our prospective cohort of 96 patients all 10 patients who had been on pre-existing metformin treatment at time of diagnosis (CS-MET). These 10 patients were matched for age, sex and BMI with 16 patients without metformin treatment (CS-NOMET). All patients had florid CS at time of diagnosis. We analyzed body composition, metabolic parameters, bone mineral density and bone remodeling markers, muscle function and quality of life. As expected, diabetes was more prevalent in the CS-MET group, and HbA1c was higher. In terms of comorbidities and the degree of hypercortisolism, the two groups were comparable. We did not observe differences in terms of muscle function or body composition. In contrast, bone mineral density in metformin-treated patients was superior to the CS-NOMET group at time of diagnosis (median T-Score -0.8 versus -1.4, p = 0.030). CS-MET patients showed decreased β-CTX levels at baseline (p = 0.041), suggesting reduced bone resorption under metformin treatment during glucocorticoid excess. This retrospective cohort study supports potential protective effects of metformin in patients with endogenous glucocorticoid excess, in particular on bone metabolism.
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DOI：
10.1210/jc.2008-1297
发表时间：
2008-12
期刊：
The Journal of clinical endocrinology and metabolism
影响因子：
--
作者：
Kola B;Christ-Crain M;Lolli F;Arnaldi G;Giacchetti G;Boscaro M;Grossman AB;Korbonits M
通讯作者：
Korbonits M
影响因子：
6.8
作者：
Morovat, Alireza;Catchpole, Anthony;Cavalier, Etienne
通讯作者：
Cavalier, Etienne
影响因子：
--
作者：
Nygaard EB;Vienberg SG;Ørskov C;Hansen HS;Andersen B
通讯作者：
Andersen B
影响因子：
5.8
作者：
Ragnarsson, Oskar;Berglund, Peter;Johannsson, Gudmundur
通讯作者：
Johannsson, Gudmundur
影响因子：
5
作者：
Sedlinsky, Claudia;Silvina Molinuevo, Maria;Desmond McCarthy, Antonio
通讯作者：
Desmond McCarthy, Antonio