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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Malignant melanoma development in gastrointestinal (GI) tract may be primary or secondary. Although small bowel, colon and stomach represent common GI sites affected from metastatic cutaneous malignant melanoma (cMM), more than 90% of the cases are identified only during autoptic examinations. Therefore, the diagnosis in a living patient of gallbladder metastasis from cMM is considered extremely rare. We aimed to describe a case of metastatic melanoma involving the gallbladder, the stomach and the small bowel in a 78-year-old male with diffuse abdominal pain and a history of cMM of the back, which was radically resected 4 years before. Abdominal ultrasound showed intracholecystic multiple nodulations. CT, besides confirming the gallbladder nodules, revealed multiple masses in the stomach, duodenum and ileum. Malignant melanoma lesions were confirmed by histopathological and immunohistochemical analyses of bioptic material obtained from endoscopic examination. In patients with history of melanoma, careful inspection of GI tract should be prompted adopting adequate imaging techniques and endoscopy in order to better influence treatment planning and prognosis.

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