Endocrine Abstracts (2017) 49 EP80 | DOI: 10.1530/endoabs.49.EP80

The effect of subclinical hypercortisolism on bone mineral density in female patients with adrenal incidentalomas

Sanja Ognjanovic, Djuro Macut, Milan Petakov, Valentina Kovacevic Elezovic, Tatjana Isailovic, Ivana Bozic Antic, Dusan Ilic, Bojana Popovic, Tamara Bogavac, Jadranka Antic & Svetozar Damjanovic


Clinic for Endocrinology, Diabetes and Metabolic Diseases, Belgrade, Serbia.


To investigate the prevalence of SH and osteoporosis in female patients with unilateral AIs (UAIs) and bilateral AIs (BAIs).

We enrolled 106 female patients, 68 (64.2%) with UAIs and 47 (35.8%) with BAIs. SH was diagnosed in the presence of serum cortisol levels after 2-day low-dose dexamethasone suppression test (LDDST) >50 nmol/l with at least one of the following parameter (midnight serum cortisol >208 nmol/L, 24-h urinary free cortisol >245 nmol/24 h, or ACTH <10 ng/l). BMD was measured with dual-energy X-ray absorptiometry at lumbar spine (LS), femoral neck (FN), and total skeleton.

No difference was noted in age, BMI, percent of postmenopausal women and years since menopause. The overall prevalence of SH was 20.2%, and was more prevalent in BAIs than UAIs patients (36.1% vs 11.8%, respectively, P=0.003). The largest tumor diameter was similar in patients with UAI and BAI (P=0.254). After adjustment for BMI, waist, and presence of BAIs, SH were associated with adrenal mass size (odds ratio (OR)=1.101, 95% CI 1.041–1.166, P=0.001) and age (OR=1.086, 95% CI 1.021–1.155, P=0.009). LS-BMD and total-BMD were lower in BAIs than in UAIs patients (0.94±0.13 vs 0.86±0.17, P=0.015, and 1.08±0.18 vs 1.02±0.14, P=0.029). There were no differences in FN-BMD. Patients with BAIs had an increased frequency of osteoporosis (46.41% vs 23.5%, respectively, P=0.036). The presence of osteoporosis was associated with SH (OR=5.775, 95%CI 1.423–23.426, P=0.014) and lower BMI (OR=1.226, 95%CI 1.071–1.405, P=0.003), after adjusting for age, menopause and vitamin-D.

This study suggests significantly higher prevalence of SH in patients with BAIs than in patients with UAIs. Tumor mass could be of importance for the amount of autonomous cortisol production. The prevalence of osteoporosis was higher in patients with BAIs due to SH.