Altered bone mass and turnover in female patients with adrenal incidentaloma: the effect of subclinical hypercortisolism
Open accessAbstract
The strategy of treatment for patients with adrenal incidentalomas (AI) may depend upon the presence of hormonal hypersecretion. Although alterations of bone turnover have been recently reported, data on bone mineral density (BMD) are not available in AI patients. We evaluated bone turnover and BMD in 32 female AI patients and 64 matched controls. Spinal and femoral BMD were similar in patients and controls. Serum bone GLA protein (6.8+/-3.5 vs. 8.8+/-3.2 ng/mL; P<0.005) and PTH (48.8+/-15.1 vs. 37.2+/-10.9 pg/mL; P<0.0001) were different in patients and controls. Patients were then subdivided into 2 groups: with (n = 8; group A) or without (n = 24; group B) subclinical hypercortisolism. PTH was higher (P<0.05) in group A than in group B and in both groups than in controls (57.1+/-13.6, 46.0+/-14.8, and 37.2+/-10.9 pg/mL, respectively), and bone GLA protein was lower in group A than in group B and controls (3.8+/-2.3, 7.5+/-3.1, and 8.8+/-3.2 ng/mL, respectively; P<0.05). Serum type I cross-linked C telopeptide and fasting urinary deoxypyridinoline/ creatinine were not different in the three groups. BMD at each site was lower (P<0.05) in group A than in group B and controls. Bone mass and metabolism are altered in AI patients with subclinical hypercortisolism and should be taken into account, therefore, when addressing the treatment of choice for these patients.
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Both trabecular and cortical bone loss have been described in patients with ACS.
“Both trabecular (65,261-263) and cortical (259,262,264-266) bone loss have been described in patients with ACS.”
From Adrenal incidentaloma (2020) · cites this paper as [259]
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 [259]
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 [43]
Low serum ACTH levels are frequently found in patients with adrenal incidentalomas.
“Low serum ACTH levels are frequently found in AI patients (19,21,32,36,40,43,44,48,49,56,60,61).”
From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [43]
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- Authors
- Torlontano, M., Chiodini, I., Pileri, M., Guglielmi, G., Cammisa, M., Modoni, S., Carnevale, V., Trischitta, V., & Scillitani, A.
- Affiliations
- Casa Sollievo della Sofferenza (IT)
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 1999-07
- Volume
- 84
- Issue
- 7
- Pages
- 2381-2385
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2140162560
- Cited by
- 91
- References
- 30
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 3 · 2023: 2 · 2022: 1 · 2021: 2 · 2020: 5 · 2019: 3 · 2018: 2 · 2017: 1 · 2016: 3 · 2015: 1 · 2014: 2 · 2013: 1 · 2012: 5
- FWCI
- 7.50
- 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)
- Institutional Research Information System University of Ferrara (University of Ferrara) (submittedVersion)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
- Topics
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal Regulation and Hypertension
- Keywords
- adrenal incidentaloma, subclinical hypercortisolism, bone mineral density, bone turnover, osteocalcin, parathyroid hormone, female patients, C-terminal telopeptide, deoxypyridinoline, bone metabolism
- MeSH terms
- Adrenal Gland Neoplasms, Adult, Aged, Amino Acids, Collagen, Creatinine, Female, Femur, Humans, Hydrocortisone, Middle Aged, Peptides, Spine, Bone Density, Osteocalcin, Bone Remodeling, Collagen Type I
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