Association of urinary free cortisol with bone formation in patients with mild autonomous cortisol secretion

Abstract

Context Mild autonomous cortisol secretion (ACS) is associated with an increased risk of vertebral fractures (VFx). However, the influence of this condition on bone turnover or its association with mild ACS is still controversial. Objective This study aimed to evaluate the impact of mild ACS on bone quality among patients living with the disease. Design and setting A retrospective study was conducted using data from 55 mild ACS and 12 nonfunctioning adrenal tumour (NFT) patients who visited Chiba University Hospital, Japan, from 2006 to 2018. Patients and main outcome measures We analysed clinical features and bone‐related factors, including bone mineral density (BMD) and VFx, performed blood tests to assess bone metabolism markers in patients with mild ACS and NFT, and assessed the associations between bone‐related markers and endocrinological parameters in patients with mild ACS. Results No significant differences between mild ACS and NFT patients were observed with respect to the presence or absence of VFx and BMD. Urinary free cortisol (UFC) was higher in mild ACS patients with VFx than those without (p = .037). The T‐score and young adult mean (YAM) of the BMD of the femoral neck in mild ACS patients with a body mass index <25 were positively correlated with dehydroepiandrosterone sulphate levels (ρ: 0.42, p = .017; ρ: 0.40, p = .024, respectively). Pearson's correlation analysis showed that bone‐specific alkaline phosphatase was negatively correlated with UFC in the patients with mild ACS (ρ: −0.37, p = .026). Conclusions These results suggest that urinary free cortisol may be useful for predicting bone formation in mild ACS patients.

Mild Autonomous Cortisol Secretion (MACS) – Related Osteoporosis

“…Reduced serum sclerostin levels were observed in patients with MACS vs. those with non-functional AI [38], which may be explained by decrease osteocyte function or numbers likely due to chronic glucocorticoid exposure. By contrast, in a Japanese study, Ishida et al [30] reported that BSAP and OC were higher in MACS (n=55) than in non-functional AI (n=12). However, in the latter study the control group consisted of only few patients, limiting the interpretation of the results.…”

“…Older studies [17][18][19][20][21][22][23][24][25][26][27][28][29] with a 1-mg DST cortisol cut-off > 3 mcg/dL showed a highly variable prevalence of vertebral fractures ranging from 43% to 100%. More recent studies performed with 1-mg DST cortisol cut-off >1.8 mcg/dL (50 nmol/L) [3,4,[30][31][32][33], demonstrated similar rates regardless of the size of the cohort, with fracture prevalence in larger cohorts ranging from 31.7% to 62.6% (Table 1).…”

Sex Difference in the Association of Osteoporosis and Osteopenia Prevalence in Patients with Adrenal Adenoma and Different Degrees of Cortisol Excess

“…Morelli et al reported that a criterion for detecting incidental vertebral fractures on adrenal incidentaloma was a 1 mg DST cortisol level >2.0 μ g/dL [ 27 ]. Several studies have demonstrated that 1 mg DST cortisol levels >1.8 μ g/dL can reduce bone quality [ 11 , 28 – 30 ].…”

Management of Adrenal Cortical Adenomas: Assessment of Bone Status in Patients with (Non-Functioning) Adrenal Incidentalomas

“…Overall, we identified 40 original studies on patients diagnosed with AI and/or ACS (or SCS) for whom bone assessments of various types were provided; a total of 3046 patients were included, with a higher prevalence of women (female-to-male ratio of 1921:1125, aged between 20.5 and 95.5 years old) [ 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 ] ( Figure 1 ).…”