ECEESPE2025 Poster Presentations Adrenal and Cardiovascular Endocrinology (169 abstracts)
Adrenalectomy reduces the risk of vertebral fractures in patients with adrenal adenoma and mild autonomous cortisol secretion
Valentina Morelli 1 , Vittoria Favero 2,3 , Sofia Frigerio 4 , Carmen Aresta 3 , Flavia Pugliese 5 , Antonio Salcuni 6 , Alessandro Risio 2 , Cristina Eller Vainicher 4 , Serena Palmieri 4 , Elisa Cairoli 1 , Sabrina Corbetta 1,7 , Alfredo Scillitani 5 , Giovanna Mantovani 4,8 & Iacopo Chiodini 2,3
1IRCCS Istituto Auxologico Italiano, Endocrinology Department of Endocrine and Metabolic Diseases, Milann, Italy; 2Department of Medical Biotechnology and Translational Medicine, Milan, Italy; 3ASST Grande Ospedale Metropolitano Niguarda, Unit of Endocrinology, Milan, Italy; 4Fondazione IRCCS Cà Granda-Ospedale Maggiore, Unit of Endocrinology, Milan, Italy; 5IRCCS Ospedale Casa Sollievo della Sofferenza, Unit of Endocrinology and Diabetology, San Giovanni Rotondo (FG), Italy; 6University-Hospital S. Maria della Misericordia, Unit of Endocrinology and Metabolism, Udine, Italy; 7University of Milan, Department of Biomedical, Surgical and Dental Sciences, Milano, Italy; 8University of Milan, Department of Clinical Sciences and Community Health, Milano, Italy
JOINT1418
Objective: Mild autonomous cortisol secretion (MACS) is associated with increased risk of vertebral fractures (VFx). However, the impact of recovery from MACS on bone health remains unclear.
Design: Retrospective Longitudinal Intervention Study (Study 1): A total of 53 patients with MACS were followed for 35.2±18.6 months (mean±S.D.). Among these, 31 patients underwent surgery (Study 1-GroupA), while 22 patients received conservative treatment (Study 1-GroupB). Prospective Randomized Study (Study 2): Fifty-one outpatients with MACS were randomly assigned to either adrenalectomy (Study 2-GroupA, 21 patients, 67% females, age 63 [56.5–72.5]) or a conservative approach (Study 2-GroupB, 28 patients, 78% females, age 69 [61–73]) and were followed for 24 months.
Methods: MACS was diagnosed in patients with adrenal incidentalomas>1 cm and cortisol after 1-mg dexamethasone suppression test (F-1 mgDST)≥1.8 μg/dL. At baseline and at the end of the follow-up we assessed: mineral metabolism, bone mineral density (BMD) at the lumbar spine (LS), total hip (TH) and femoral neck (FN) using Dual-energy X-ray Absorptiometry, and clinical and morphometric vertebral fractures (VFx).
Results: Study 1: Study 1-GroupB showed an increased incidence of VFx (n=11) at the end of the follow-up when compared to Study1-GroupA (n=3, P<0.05). In both groups, BMD at LS, FN and TH were similar at baseline and at the end of follow-up. In Study 1-GroupB, a new VFx occurred in 50% of patients, including 2 out of the 5 patients treated with bisphosphonates; in GroupA, 3 patients (9.7%) experienced incident VFx, all having a prevalent VFx at baseline. Study 2: Patients in both groups were comparable for demographic features (age, sex, BMI), adenoma’s size, cortisol secretion parameters (F-1 mgDST, urinary free cortisol, ACTH), prevalent VFx and BMD at baseline. After 24 months, in Study 2-GroupA, we observed significant increases in calcium and phosphate levels compared to baseline (P=0.03 and P=0.04, respectively). In Study 2-GroupB, no significant changes were noted when comparing baseline values with those after 24 months. Additionally, at the end of follow up, BMD remained stable across both groups. However, Study 2-GroupB showed a significantly higher incidence (n=7, 25%) of VFx by the end of the follow-up period compared to Study 2-GroupA (n=1, 4.8%, P=0.04).
Conclusions: In patients with unilateral adrenal incidentalomas and MACS, adrenalectomy significantly reduces the risk of vertebral fractures.
Volume 110
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Endocrine Abstracts
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