Does subclinical hypercortisolism adversely affect the bone mineral density of patients with adrenal incidentalomas?

Hadjidakis, D.; Tsagarakis, Stylianos; Roboti, C.; Sfakianakis, Michael; Iconomidou, Vassiliki A.; Raptis, Sotirios A.; Thalassinos, Nikolaos

doi:10.1046/j.1365-2265.2003.01676.x

Cited by 55 publications

(52 citation statements)

References 39 publications

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“…Differences in the devices used to estimate bone density and in selection criteria of either patients or controls, along with the small number of subjects studied, are likely explanations for the divergent results. An increased risk of osteoporosis has been documented by the most recent studies that addressed this issue (37)(38)(39)(40). Moreover, in a recent study an increased prevalence of vertebral fractures in women with subclinical Cushing' syndrome was found, corroborating the notion that even subtle glucocorticoid excess can exert a detrimental effect on bone quality, particularly in condition of estrogen deficiency (41).…”

Section: Natural Historymentioning

confidence: 70%

Subclinical Cushing's Syndrome

et al. 2004

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Subclinical Cushing's syndrome (CS) is attracting increasing interest since the serendipitous discovery of an adrenal mass has become a rather frequent event owing to the routine use of sophisticated radiologic techniques. Cortical adenoma is the most frequent type of adrenal incidentaloma accounting for approximately 50% of cases in surgical series and even greater shares in medical series. Incidentally discovered adrenal adenomas may secrete cortisol in an autonomous manner that is not fully restrained by pituitary feedback, in 5 to 20% of cases depending on study protocols and diagnostic criteria. The criteria for qualifying subclinical cortisol excess are controversial and presently there is no consensus on a gold standard for the diagnosis of this condition. An increased frequency of hypertension, central obesity, impaired glucose tolerance, diabetes and hyperlipemia has been described in patients with subclinical CS; however, there is still no clear demonstration of the long-term complications of this condition whose management remains largely empirical. Either adrenalectomy or careful observation associated with treatment of the metabolic syndrome have been suggested as treatment options. RESUMO Síndrome de Cushing Subclínica.A síndrome de Cushing subclínica (SCS) tem atraído interesse cada vez maior desde que a descoberta casual de uma massa adrenal se tornou um evento freqüente devido ao emprego rotineiro de técnicas sofisticadas de imagem. O adenoma cortical é o tipo mais freqüente de incidentaloma adrenal, correspondendo a cerca de 50% dos casos em séries cirúrgicas e até mais do que isso em séries médicas. Adenomas adrenais descobertos incidentalmente podem secretar cortisol de maneira autônoma ou não controlada totalmente pelo feedback hipofisário, em 5 a 20% dos casos, dependendo do protocolo de estudo e dos critérios diagnósticos. Os critérios para qualificar um excesso subclínico de cortisol são controversos e atualmente não existe consenso a respeito de "padrão ouro" para o diagnóstico dessa condição. Em pacientes com SCS, tem sido descrita uma freqüência elevada de hipertensão, obesidade central, intolerância à glicose, diabetes e hiperlipemia; entretanto, ainda não existe uma evidente demonstração de complicações a longo prazo dessa condição, cujo manejo permanece amplamente empírico. Tanto a adrenalectomia como a observação cuidadosa, associada com o tratamento da síndrome metabólica, têm sido sugeridos como opções terapêuticas.

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Section: Natural Historymentioning

confidence: 70%

Subclinical Cushing's Syndrome

et al. 2004

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“…In recent years, the majority (5)(6)(7)(8)(9)31) but not all (10) cross-sectional studies have suggested that SH is associated with an increased prevalence of osteoporosis. However, only one longitudinal study specifically investigated the rate of spinal and femoral bone loss in female patients with adrenal incidentalomas so far.…”

Section: Discussionmentioning

confidence: 99%

Risk of new vertebral fractures in patients with adrenal incidentaloma with and without subclinical hypercortisolism: A multicenter longitudinal study

Morelli

Eller-Vainicher

Salcuni

et al. 2011

Journal of Bone and Mineral Research

121

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In patients with adrenal incidentalomas (AIs), cross-sectional studies suggested the presence of an association between subclinical hypercortisolism (SH) and an increased prevalence of vertebral fractures (VFx) and spinal deformity index (SDI), which is a clinical index of bone quality. No longitudinal studies investigated the incidence of VFx and SDI changes over time in SH. The aim of this study was to evaluate VFx risk and SDI changes in SH over time. One-hundred-three consecutive AI patients were studied at baseline and after 12 and 24 months. Patients were divided into SH þ (n ¼ 27) and SH -(n ¼ 76) groups on the basis of the presence of two or more among urinary free cortisol greater than 70 mg/24 hours, serum cortisol after 1-mg dexamethasone suppression test greater than 3.0 mg/dL, and adrenocorticotropic hormone (ACTH) less than 10 pg/mL in 2 or more of the 3 evaluations. At baseline and after 24 months, bone mineral density (BMD) by dual-energy X-ray absorptiometry and the presence of VFx and SDI by summing the grade of deformity for each vertebra were evaluated. At the end of follow-up, the SH þ group showed a higher prevalence of VFx (81.5%) as compared with baseline (55.6%, p ¼ .04) and a worsening of SDI (2.11 AE 1.85 versus 1.11 AE 1.47, p ¼ .032) associated with SH regardless of age, gender, body mass index , BMD, baseline SDI, menopause duration [odds ratio (OR) ¼ 12.3, 95% confidence interval (CI) 4.1-36.5, p ¼ .001]. The incidence of new vertebral fractures was higher in the SH þ group (48%) than in the SH -group (13%; p ¼ .001). It is concluded that subclinical hypercortisolism is associated with an increased risk of VFx and a possible deterioration of bone quality. ß

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“…2 In fact, in spite of the definition of 'subclinical' hypercortisolism, this condition of subtle cortisol excess has been described to be associated with the presence of classic, even not specific, complications of overt cortisol excess as obesity, type 2 diabetes, hypertension and bone loss. [4][5][6][7][8][9][10][11][12][23][24][25] Regarding bone involvement in the presence of SH, no data are reported so far regarding vertebral fractures in male patients. Thus, the most important finding of the present investigation is that in male patients with AI and SH the proportion of vertebral fractures is increased.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 This condition has been suggested to be associated to several complications, including bone loss, which is a typical feature, even not specific, of overt cortisol excess. 4 Indeed, most of the previous studies, [5][6][7][8][9][10][11][12] even not all, 13-15 strongly suggested a possible negative effect of SH on bone. Nevertheless, data about the most common complication of bone loss, such as vertebral fractures, are scarce.…”

Section: Introductionmentioning

confidence: 99%

Eugonadal male patients with adrenal incidentalomas and subclinical hypercortisolism have increased rate of vertebral fractures

Chiodini

Viti²,

Coletti

et al. 2009

Clinical Endocrinology

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SummaryObjective Subclinical hypercortisolism (SH) is suggested to exert a deleterious effect on bone. This effect and the role of gonadal status in male subjects are not fully elucidated. We evaluated bone mineral density (BMD) and prevalence of vertebral fractures in eugonadal male subjects with adrenal incidentalomas (AI) and without SH. Design This 12-month observational multicentre study was performed between January and December 2006 on inpatient basis in three referral Italian centres. Patients Eighty-eight consecutive eugonadal male patients with AI and 90 matched control subjects were studied. Measurements All subjects underwent the determination of BMD by dual-energy X-ray absorptiometry at lumbar spine (LS) and femoral neck (FN), and spinal radiograph. In AI patients SH was diagnosed in the presence of two of the following: urinary free cortisol > 193·1 nmol/l, cortisol after 1 mg dexamethasone suppression test > 82·8 nmol/l, ACTH levels < 2·2 pmol/l. Results As compared to patients without SH (SH-, n = 66) and controls, patients with SH (SH+, n = 22) had lower BMD at LS ( Z -score: SH+, -1·04 ± 1·84; SH-, 0·19 ± 1·34, Controls 0·20 ± 1·28, P = 0·001 and FN ( Z -score: SH+, -0·63 ± 1·01; SH-, 0·01 ± 1·01, Controls 0·26 ± 1·06, P = 0·002) and higher prevalence of fractures (SH+, 72·7%; SH-, 21·2%, Controls 20·0%, P = 0·0001). Multivariable analyses showed that SH was associated to BMD at LS ( β = -0·378, P = 0·0001) and vertebral fractures (OR = 7·81, 95% CI 1·96 -31·17, P = 0·004). ConclusionIn eugonadal male patients with AI, SH is associated with low BMD and high prevalence of vertebral fractures.

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Does subclinical hypercortisolism adversely affect the bone mineral density of patients with adrenal incidentalomas?

Cited by 55 publications

References 39 publications

Subclinical Cushing's Syndrome

Subclinical Cushing's Syndrome

Risk of new vertebral fractures in patients with adrenal incidentaloma with and without subclinical hypercortisolism: A multicenter longitudinal study

Eugonadal male patients with adrenal incidentalomas and subclinical hypercortisolism have increased rate of vertebral fractures

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