TY - JOUR
TI - Does subclinical hypercortisolism adversely affect the bone mineral
density of patients with adrenal incidentalomas?
AU - Hadjidakis, D
AU - Tsagarakis, S
AU - Roboti, C
AU - Sfakianakis, M and
AU - Iconomidou, V
AU - Raptis, SA
AU - Thalassinos, N
JO - Clinical Endocrinology
PY - 2003
VL - 58
TODO - 1
SP - 72-77
PB - Wiley-Blackwell Publishing Ltd
SN - 0300-0664, 1365-2265
TODO - 10.1046/j.1365-2265.2003.01676.x
TODO - null
TODO - OBJECTIVE Subclinical hypercortisolism (SH) is detected increasingly in
a substantial proportion of patients with incidentally discovered
adrenal adenomas. The clinical implications of SH are currently unclear.
Osteoporosis is a well-known complication of glucocorticoid excess. So
far, the impact of SH on bone mineral density (BMD) has been studied in
a limited number of reports with discordant results. In the present
study we evaluated the BMD in a large cohort of post-menopausal women
with adrenal incidentalomas.
PATIENTS AND MEASUREMENTS Forty-two post-menopausal women with
incidentally discovered adrenal masses and radiological features highly
suggestive of benign adrenal adenomas were investigated. All patients
underwent a standard low-dose dexamethasone suppression test (LDDST; 0.5
mg 6-hourly for 2 days). The diagnosis of subclinical hypercortisolism
(SH) was based on post-LDDST cortisol concentrations of >70 nmol/l.
According to this criterion patients were subdivided into two groups:
with (n = 18; group A) or without (n = 24; group B) SH. There was no
significant difference in age, years since menopause and body mass index
between these groups. BMD was measured at L2-L4 vertebrae and three
sites of the proximal femur by the dual energy X-ray absorptiometry
(DEXA) method.
RESULTS Post-menopausal women with SH (group A) exhibited slightly but
significantly lower absolute and age-adjusted BMD values compared to
group B patients in the femoral neck (BMD g/cm(2): 0.72 +/- 0.08 vs.
0.79 +/- 0.09; Z -score: -0.20 +/- 0.82 vs. +0.43 +/- 0.94, P < 0.05)
and trochanter (BMD g/cm(2): 0.60 +/- 0.09 vs. 0.69 +/- 0.10; Z-score:
-0.32 +/- 1.0 vs. +0.30 +/- 1.05, P < 0.01). BMD measurements of the
Ward’s triangle were also lower in group A patients but the difference
did not reach statistical significance (BMD g/cm(2): 0.60 +/- 0.10 vs.
0.68 +/- 0.13, P = 0.06). There was no difference in the lumbar
vertebrae between the two groups (BMD g/cm(2): 0.888 +/- 0.13 vs. 0.90
+/- 0.16, P = 0.78; z-score: +0.50 +/- 1.16 vs. +0.11 +/- 1.5, P =
0.36). The number of patients in the osteoporotic range was minimal with
no significant difference between the two groups. However, the frequency
of osteopenia in group A was significantly greater than in group B
patients in the trochanter and Ward’s triangle areas. Serum osteocalcin
(BGP) levels were significantly lower in group A compared to group B
patients (18.6 +/- 8.6 vs. 26.2 +/- 8.1 ng/ml, P < 0.01); no difference
existed regarding parathyroid hormone (PTH) concentrations (43 +/- 15.6
vs. 41.2 +/- 14.8 pg/ml, P = 0.72).
CONCLUSIONS In this series, post-menopausal women with subclinical
hypercortisolism had lower absolute and age-adjusted BMD values and a
higher rate of osteopaenia in the trabecular loaded and mixed
cortical-trabecular bone of proximal femur. These data demonstrate that
the subtle hypercortisolism of patients with adrenal incidentalomas may
have an adverse effect on the bone mass of these patients.
ER -