Endocrine Abstracts

Bone involvement in patients with adrenal incidentalomas: role of subclinical hypercortisolism

I Chiodini, F Coletti, P Epaminonda, S Di Lembo, V Morelli, B Masserini, G Adda & M Arosio

Unit of Endocrinology, San Giuseppe-Fatebenefratelli Hopital, AFaR, Milan, Italy.

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Previous studies suggest that in patients with adrenal incidentalomas (AI) subclinical hypercortisolism (SH) exerts a deleterious effect on bone mineral density (BMD), but scarce data are available about vertebral fractures. We evaluate BMD and prevalence of vertebral fractures in a sample of AI subjects with and without SH.

Forty-seven consecutive AI inpatients were evaluated (17M, 30F). The patients were subdivided into two groups: with or without subclinical hypercortisolism (SH+/SH−). The diagnosis of SH was made on the presence of 2 of the following 3 alterations in the pituitary-adrenal axis: urinary free cortisol (UFC) levels higher than 70 mcg/24 hrs, serum cortisol levels after a 1-mg overnight dexamethasone suppression test (F after Dex) higher than 3.0 mcg/dL, and ACTH levels lower than 10 pg/mL. In all patients spinal and femoral BMD was measured by DXA and expressed as Z-score (LS Z-score, FN Z-score respectively). Results are shown in Table 1.

	SH+ (n=14)	SH− (n=33)
Age (Yrs)	71.6±11.1	67.3±10
Gender (M/F)	6/8	11/22
Diameter of adenoma (cm)	2.04±0.88	2.46±0.42
BMI (Kg/m2)	28.1±4.7	27.9±7.1
Prevalence of osteoporosis (%)	20	15
Z-score LS (g/cm2)	−0.89±1.092	0.184±0.894
Z-score FN (g/cm2)	−0.20±0.602	0.342±0.948
Vertebral Fractures: (%)	88.9*	16.7
Data are mean±S.D.; *P=0.001. In the logistic regression analysis, significant predictor of vertebral fracture was F-Dex (OR 0.024,CI 95% 0.002–0.315, P=0.005) but not age and BMI.

In patients with adrenal incidentalomas, SH is associated to a higher prevalence of vertebral fractures related to the degree of cortisol secretion. Bone involvement has to be evaluated in AI patients with SH.

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Endocrine Abstracts (2006) 11 OC53