Eugonadal male patients with adrenal incidentalomas and subclinical hypercortisolism have increased rate of vertebral fractures.
OBJECTIVE
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.


METHODS
This 12-month observational multicentre study was performed between January and December 2006 on inpatient basis in three referral Italian centres.


METHODS
Eighty-eight consecutive eugonadal male patients with AI and 90 matched control subjects were studied.


METHODS
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 (beta = -0.378, P = 0.0001) and vertebral fractures (OR = 7.81, 95% CI 1.96-31.17, P = 0.004).


CONCLUSIONS
In eugonadal male patients with AI, SH is associated with low BMD and high prevalence of vertebral fractures.
Department of Medical Sciences, University of Milan, Endocrinology and Diabetology Unit, Fondazione Policlinico, Mangiagalli e Regina Elena, IRCCS, Milan, Italy. iacopo.chiodini@email.it
Iacopo
I
Chiodini
Raffaella
R
Viti
Francesca
F
Coletti
Giuseppe
G
Guglielmi
Claudia
C
Battista
Federica
F
Ermetici
Valentina
V
Morelli
Antonio
A
Salcuni
Vincenzo
V
Carnevale
Filomena
F
Urbano
Silvana
S
Muscarella
Bruno
B
Ambrosi
Maura
M
Arosio
Paolo
P
Beck-Peccoz
Alfredo
A
Scillitani
D000306:Adrenal Cortex Neoplasms / Q000150:complications* / Q000503:physiopathology; D018246:Adrenocortical Adenoma / Q000150:complications* / Q000503:physiopathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density / Q000502:physiology; D016022:Case-Control Studies; D003480:Cushing Syndrome / Q000150:complications* / Q000503:physiopathology; D005265:Femoral Neck Fractures / Q000453:epidemiology; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism; D033162:Incidental Findings; D007558:Italy; D008159:Lumbar Vertebrae / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D012307:Risk Factors; D016103:Spinal Fractures / Q000453:epidemiology*; D013737:Testis / Q000503:physiopathology
D006854:Hydrocortisone