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Cited by 73Bone health and osteoporosis researchAdrenal Hormones and DisordersHormonal Regulation and Hypertension

Mechanisms in endocrinology: endogenous subclinical hypercortisolism and bone: a clinical review

Chiodini, I, Vainicher, C Eller, Morelli, V, Palmieri, S, Cairoli, E, Salcuni, A S, Copetti, M, Scillitani, A·2016·European Journal of Endocrinology
DOI 10.1530/eje-16-0289
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Abstract

In recent years, the condition of subclinical hypercortisolism (SH) has become a topic of growing interest. This is due to the fact that SH prevalence is not negligible (0.8-2% in the general population) and that, although asymptomatic, this subtle cortisol excess is not harmless, being associated with an increased risk of complications, in particular of osteoporosis and fragility fractures. As specific symptoms of hypercortisolism are absent in SH, the SH diagnosis relies only on biochemical tests and it is a challenge for physicians. As a consequence, even the indications for the evaluation of bone involvement in SH patients are debatable and guidelines are not available. Finally, the relative importance of bone density, bone quality and glucocorticoid sensitivity in SH is a recent field of research. On the other hand, SH prevalence seems to be increased in osteoporotic patients, in whom a vertebral fracture may be the presenting symptom of an otherwise asymptomatic cortisol excess. Therefore, the issue of who and how to screen for SH among the osteoporotic patients is widely debated. The present review will summarize the available data regarding the bone turnover, bone mineral density, bone quality and risk of fracture in patients with endogenous SH. In addition, the role of the individual glucocorticoid sensitivity in SH-related bone damage and the problem of diagnosing and managing the bone consequences of SH will be reviewed. Finally, the issue of suspecting and screening for SH patients with apparent primary osteoporosis will be addressed.

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Crossref · 10.1530/eje-16-0289

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  • A meta-analysis reported a prevalence of vertebral fracture in patients with ACS of 63.6% (95% CI 55.98-71.26%).

    “For bone fracture, a meta-analysis reported a prevalence of vertebral fracture in patients with ACS of 63.6% (95% CI 55.98-71.26%) (254)”

    From Adrenal incidentaloma (2020) · cites this paper as [254]

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Authors
Chiodini, I., Vainicher, C. E., Morelli, V, Palmieri, S., Cairoli, E., Salcuni, A. S., Copetti, M., & Scillitani, A.
Affiliations
  • Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT)
  • 1Unit of Endocrinology and Metabolic DiseasesFondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy
  • University of Milan (IT)
  • University of Cagliari (IT)
  • 4Unit of Biostatistics
  • Casa Sollievo della Sofferenza (IT)
Corresponding author
Chiodini, I
ORCID
Venue
European Journal of Endocrinology
Publisher
Oxford University Press (OUP)
Published
2016-12
Volume
175
Issue
6
Pages
R265-R282
ISSN
  • 0804-4643 (ISSN-L)
  • 1479-683X
DOI
10.1530/eje-16-0289
OpenAlex
W2472423566
Cited by
73
References
136
Citations by year
2026: 5 · 2025: 5 · 2024: 9 · 2023: 5 · 2022: 8 · 2021: 15 · 2020: 10 · 2019: 5 · 2018: 6 · 2017: 5
FWCI
0.85
Type
journal article
Language
en
Open access
closed
Locations
  • European Journal of Endocrinology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal Regulation and Hypertension
Keywords
subclinical hypercortisolism, endogenous hypercortisolism, bone health, osteoporosis, fragility fractures, bone mineral density, bone quality, bone turnover, glucocorticoid sensitivity, fracture risk, primary osteoporosis
MeSH terms
Cushing Syndrome, Humans, Osteoporosis, Bone Density, Bone Remodeling

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