Available online 10 May 2024, 101501

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Preclinical and animal studies have suggested that excess catecholamines can lead to bone mineral loss. However, to date, no systematic review is available that has analyzed the impact of catecholamine excess in the context of pheochromocytoma/paraganglioma (PPGL) on bone metabolism. We conducted this meta-analysis to address this knowledge gap.

Methods

Electronic databases were searched for studies evaluating bone metabolism, including assessments of bone mineral density (BMD), quantitative computed tomography (qCT), trabecular bone score (TBS), or bone turnover markers in patients with PPGL. These markers included those of bone resorption, such as tartrate-resistant acid phosphatase 5b (TRACP-5b) and cross-linked C-telopeptide of type I collagen (CTx), as well as markers of bone formation, such as bone-specific alkaline phosphatase (BS ALP).

Results

Out of the initially screened 1614 articles, data from six studies published in four different patient cohorts with PPGL that met all criteria were analysed. Individuals with PPGL had significantly lower TBS [Mean Difference (MD) -0.04 (95% CI: -0.05–-0.03); P < 0.00001; I2 = 0%], higher serum CTx [MD 0.13 ng/ml (95% CI: 0.08–0.17); P < 0.00001; I2 = 0%], and higher BS-ALP [MD 1.47 U/L (95% CI: 0.30–2.64); P = 0.01; I2 = 1%]. TBS at 4-7 months post-surgery was significantly higher compared to baseline [MD 0.05 (95% CI: 0.02–0.07); P < 0.0001]. A decrease in CTx has been documented post-surgery.

Conclusion

Bone health deterioration is a major concern in patients with PPGL. In addition to providing a definitive cure for catecholamine excess, monitoring and treating osteoporosis are essential for individuals with secondary osteoporosis due to PPGL. Long-term studies on bone health outcomes in PPGL are warranted

Section snippetsMethods

The meta-analysis was carried out according to the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions.10 The predefined protocol has been registered in PROSPERO and has the registration number: CRD42023437740. All randomized controlled trials (RCTs), case control studies, and cohort studies published till May 2023 were considered for this systematic review. This meta-analysis has been reported in accordance with the Preferred Reporting Items for Systematic Reviews

Results

A total of 1614 articles were found after the initial search (Figure-1). Following the screening of the titles, abstracts, followed by full-texts, the search was reduced down to 31 studies which were evaluated in detail for inclusion in this meta-analysis (Figure-1). Data from 6 studies which fulfilled all criteria were analysed in this systematic review.6, 7, 8, 9,17,18. Data from studies by Kim et al was from a single cohort of patients and was considered as a single study. Similarly, data

Discussion

Our meta-analysis demonstrates the detrimental effects of catecholamine excess secondary to PPGL on bone. Our study revealed that individuals living with pheochromocytoma exhibited significantly lower BMD at the lumbar spine and a markedly higher bone turnover rate, which subsequently decreased following adrenalectomy. CTx concentrations at baseline which markedly reduce after surgery can guide assessment of bone turnover in PPGL.

Newer imaging techniques continue to advance, offering even more

Funding

None

Declaration of competing interest

None

Bibliography (23)S Khatiwada et al.Prevalence and Predictors of Osteoporosis/BMD Below Expected Range for Age in Pheochromocytoma/Paraganglioma and BMD, TBS Change Post-Operatively: A Prospective Cohort Study

Indian J Endocrinol Metab

(2023)

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© 2024 The International Society for Clinical Densitometry. Published by Elsevier Inc.