The Occurrence of Subclinical Hypercortisolism and Osteoporosis in Patients with Incidentally Discovered Unilateral and Bilateral Adrenal Tumors

Abstract

SummaryBackgroundAdrenal incidentalomas (AI) are clinically silent adrenal masses that are detected incidentally during imaging procedures performed for unrelated diseases. The aim of this study was to investigate the prevalence of sub-clinical hypercortisolism (SH) and associated co-morbidities in patients with unilateral AI (UAI) and bilateral AI (BAI).MethodsWe evaluated 152 patients, 105 (69.1%) with UAI and 47 (30.9%) with BAI. SH was diagnosed in the presence of serum cortisol levels after 1 mg dexamethasone suppression test (DST) or after 2-day low-dose DST (LDDST) > 50 nmol/L with at least one of the following parameters: midnight serum cortisol > 208 nmol/L, 24-h urinary free cortisol > 245 nmol/24 h, or ACTH < 10 ng/L. Bone mineral density (BMD) was measured at lumbar spine (LS) and femoral neck (FN).ResultsAge, BMI, and waist circumference were comparable, and diabetes, hypertension and dyslipidemia occurred with similar frequency in both groups. The overall prevalence of SH was 20.5% based on post-1 mg DST, and 20.0% based on post-LDDST cortisol levels, and it was more prevalent in BAI than UAI patients (31.1% vs 15.2%, respectively, p=0.026). LS BMD was lower in BAI than in UAI patients (0.96±0.14 vs 0.87±0.15, p=0.002). There were no differences in FN BMD. The prevalence of osteoporosis was higher in BAI compared to UAI patients (37.1% vs 15.9%, respectively, p=0.011).ConclusionsPatients with BAI had higher prevalence of SH and osteoporosis than those with UAI. Frequency of other co-morbidities was similar. This may be due to the higher degree of autonomous cortisol secretion or different tissue-specific sensitivity to glucocorticoids.

Management of Adrenal Cortical Adenomas: Assessment of Bone Status in Patients with (Non-Functioning) Adrenal Incidentalomas

“…The mentioned studies used various endocrine criteria in order to define the cortisol excess as seen in ACS (or equivalent) [ 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 ]. ( Table 2 ).…”

“…Overall, we identified 40 original studies on patients diagnosed with AI and/or ACS (or SCS) for whom bone assessments of various types were provided; a total of 3046 patients were included, with a higher prevalence of women (female-to-male ratio of 1921:1125, aged between 20.5 and 95.5 years old) [ 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 ] ( Figure 1 ).…”

Comorbidities in Mild Autonomous Cortisol Secretion – A Clinical Review of Literature

“…The prevalence of osteoporosis and mACS itself is higher in BAI than in unilateral lesions 23 24 . Moreover, in the lumbar spine, BMD was found to be lower in BAI; however, remained the same at the femoral neck 23 . These findings further suggest that cortical bone is not so affected as trabecular.…”

“…Bone loss occurs mostly in trabecular bone, but there is also evidence that cortical bone might be affected, showing an association of mACS with BMD at FN but not at LS [19]. The prevalence of osteoporosis and mACS itself is higher in BAI than in unilateral lesions [23,24]. Moreover, in the lumbar spine, BMD was found to be lower in BAI; however, remained the same at the femoral neck [23] .…”

Osteoporosis and adrenal incidentaloma: To be or not to be?

“…Another study on 152 subjects with adrenal incidentaloma (2/3 had unilateral lesions and 1/3 had bilateral lesions) showed that among them 20% had subclinical Cushing's syndrome (more frequent in bilateral tumours) but the bone mineral density based on DXA at central sites (lumbar spine and femoral neck) was similar between the subgroups (21). Another meta-analysis based on 6 studies including 1239 patients with adrenal incidentaloma showed that metabolic complications as well as osteoporosis do not differ if the incidentaloma is uni or bilateral (22).…”