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Diagnostic work-up in steroid myopathy

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Abstract

Introduction

Steroid myopathy is a well-known sign of endogenous Cushing’s syndrome as well as a side effect of glucocorticoid administration. The clinical finding of muscle weakness and the clinical inspection of the muscle size are the most commonly used diagnostic tools, sometimes in combination with needle electromyography, but there are no means to detect the myopathy before the appearance of clinical or electrodiagnostic signs. Until now, no guidelines have been produced for a disease-specific evaluation of muscle impairment in patients with Cushing’s syndrome.

Review

We reviewed the measurement properties and limitations of the following tools that are currently adopted in clinical research and routine care for diagnosis and monitoring of steroid myopathy: muscle strength assessment; needle biopsy; intramuscular and surface electromyography; laboratory assays; muscle mass assessments (through bioelectrical impedance analysis, dual-energy X-ray absorptiometry, and computed tomography).

Conclusions

We suggest that the management of steroid myopathy patients in clinical research and practice would benefit from a multidisciplinary approach based on the combined assessment of muscle mass, strength, and performance. However, further studies are required to establish an operational definition of steroid myopathy and to identify population-specific criteria for diagnosis of the myopathic process.

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Authors and Affiliations

  1. Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy

    Marco Alessandro Minetto

  2. Division of Physical Medicine and Rehabilitation, Department of Surgical Sciences, University of Turin, Turin, Italy

    Marco Alessandro Minetto

  3. Oncological Endocrinology Unit, Department of Medical Sciences, University of Turin, Turin, Italy

    Valentina D’Angelo

  4. Department of Translational Neurosciences and Neurotherapeutics, John Wayne Cancer Institute and Pacific Neuroscience Institute, Santa Monica, CA, USA

    Santosh Kesari

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  1. Marco Alessandro Minetto
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  2. Valentina D’Angelo
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  3. Emanuela Arvat
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  4. Santosh Kesari
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Correspondence to Marco Alessandro Minetto.

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Minetto, M.A., D’Angelo, V., Arvat, E. et al. Diagnostic work-up in steroid myopathy. Endocrine 60, 219–223 (2018). https://doi.org/10.1007/s12020-017-1472-5

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