Menopausal status and severe pathological conditions: is there a place for bone and neuroendocrine markers?

Introduction. Menopause involves skeletal losses, which may be accelerated by breast cancer and associated therapy, as aromatase inhibitors. Case presentation. A 67-year old Caucasian female underwent 2 years ago a right mastectomy for breast cancer (invasive ductal carcinoma of mucinous type; 85-90% positive reaction of estrogen receptor). Synchronously, she presented, at computer tomography, a left adrenal hyperplasia, stationary during follow-up. Tamoxifen was continued for two years, then a switch to anastrozole was done for the last four months. On admission, the assays showed a non-secretor adrenal pattern, with negative neuroendocrine markers, including serum serotonin. Bone profile pointed mild hypercalcemia with normal parathormone levels, as well as bone turnover markers and 25-hydroxyvitamin D (negative imagery scan for bone metastases). Dual-Energy X-Ray Absorptiometry (DXA) revealed osteopenia with a mid deterioration of Trabecular Bone Score (TBS) at 1220. Further continuation of aromatase inhibitor is recommended, in association with vitamin D supplementation and monthly oral risendronate, good hydration and serial calcium assays. Conclusion. Modern approach of menopausal breast cancer with aromatase inhibitors increases the speed of age-related bone loss, while detailed imagery may find otherwise unknown artefacts as non-tumour enlargement of adrenal glands. Whether neuroendocrine markers like 5-hydroxytryptamine will find a place in this particular context, apart from traditional bone indices, is still difficult to establish.