Bone involvement in eugonadal male patients with adrenal incidentaloma and subclinical hypercortisolism
Open accessAbstract
Adrenal incidentalomas (AI) are not associated, by definition, with clinically evident syndromes; however, some AI patients may show biochemical indexes of subclinical hypercortisolism (SH). Previous data on female AI patients indicated that SH may lead to bone loss, at least at spine. No data are available on bone involvement in samples of only AI male patients. We measured bone metabolism and bone mineral density at spine and femur by dual-energy x-ray absorptiometry in 38 consecutive eugonadal male AI patients and 38 healthy matched control subjects. Patients were subdivided according to the presence or absence of SH (group SH+ and group SH-, respectively). Mean Z-score levels of spinal bone mineral density measured by dual-energy x-ray absorptiometry were lower (P < 0.05) in group SH+ (-0.42 +/- 1.62) in comparison with group SH- (0.6 +/- 1.13) and controls (0.47 +/- 1.06). Thus, in order for the most appropriate management to be individually tailored, bone mass evaluation is strongly indicated in AI male patients with SH, irrespective of their gonadal status.
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In patients with ACS, bone formation is reported as decreased, normal, or increased alongside normal bone resorption.
“However, in patients with ACS, a mixed picture is reported with either decreased, normal, or even increased bone formation reported alongside normal bone resorption (229,242,259-262).”
From Adrenal incidentaloma (2020) · cites this paper as [242]
In more than 25% of patients with adrenal incidentalomas, cortisol is not suppressed after 1-mg or 3-mg overnight dexamethasone suppression testing or 2-day low-dose dexamethasone suppression testing.
“In more than 25% of AI subjects, the lack of cortisol suppression after 1-or 3-mg overnight DST or 2-d low-dose DST (LDDST) (19,34,41,44,46,48,53,55,56,60,61)”
From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [53]
Few studies have reported elevated urinary free cortisol levels in more than 25% of patients with adrenal incidentalomas.
“Few studies reported a high frequency (i.e. higher than 25%) of elevated UFC levels in patients with AI (21,43,48,49,53,60).”
From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [53]
Several studies and the French Society for Endocrinology have proposed a lower 1-mg dexamethasone suppression test cutoff to increase sensitivity.
“Several studies (19,21,32,34,38,39,44,46,49,53,60,61,67) and recently the French Society for Endocrinology (68), however, have proposed a lower cutoff to increase sensitivity.”
From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [53]
With lower 1-mg dexamethasone suppression test cutoffs of 1.8 and 2.2 g/dl, specificity decreased to 67-72% and sensitivity increased to 75-100%.
“However, if the lowest cutoffs were used [1.8 and 2.2 g/dl (50 and 60.6 nmol/liter), respectively], specificity decreased to 67-72%, whereas sensitivity increased to 75-100% (48 -62, 64 -67).”
From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [53]
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References 28 · Cited by 63
- Authors
- Chiodini, I., Tauchmanovà, L., Torlontano, M., Battista, C., Guglielmi, G., Cammisa, M., Colao, A., Carnevale, V., Rossi, R., Di Lembo, S., Trischitta, V., & Scillitani, A.
- Affiliations
- Casa Sollievo della Sofferenza (IT)
- Federico II University Hospital (IT)
- Sapienza University of Rome (IT)
- Corresponding author
- Scillitani, Alfredo
- ORCID
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2002-12
- Volume
- 87
- Issue
- 12
- Pages
- 5491-5494
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2103587506
- Cited by
- 63
- References
- 28
- Citations by year
- 2026: 1 · 2024: 3 · 2023: 4 · 2022: 3 · 2020: 5 · 2019: 3 · 2018: 2 · 2016: 4 · 2015: 3 · 2013: 3 · 2012: 4
- FWCI
- 2.54
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Archivio Istituzionale della Ricerca (Universita Degli Studi Di Milano) (submittedVersion, other-oa)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Keywords
- adrenal incidentaloma, subclinical hypercortisolism, bone mineral density, bone loss, bone metabolism, spinal bone mineral density, femoral bone density, Z-score
- MeSH terms
- Adenoma, Adrenocortical Hyperfunction, Adrenal Gland Neoplasms, Adult, Aged, Bone and Bones, Cross-Sectional Studies, Femur, Humans, Male, Middle Aged, Reference Values, Spine, Absorptiometry, Photon, Bone Density
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