title: Risk of new vertebral fractures in patients with adrenal incidentaloma with and without subclinical hypercortisolism: a multicenter longitudinal study.
abstract: In patients with adrenal incidentalomas (AIs), cross-sectional studies suggested the presence of an association between subclinical hypercortisolism (SH) and an increased prevalence of vertebral fractures (VFx) and spinal deformity index (SDI), which is a clinical index of bone quality. No longitudinal studies investigated the incidence of VFx and SDI changes over time in SH. The aim of this study was to evaluate VFx risk and SDI changes in SH over time. One-hundred-three consecutive AI patients were studied at baseline and after 12 and 24 months. Patients were divided into SH(+) (n = 27) and SH(-) (n = 76) groups on the basis of the presence of two or more among urinary free cortisol greater than 70 µg/24 hours, serum cortisol after 1-mg dexamethasone suppression test greater than 3.0 µg/dL, and adrenocorticotropic hormone (ACTH) less than 10 pg/mL in 2 or more of the 3 evaluations. At baseline and after 24 months, bone mineral density (BMD) by dual-energy X-ray absorptiometry and the presence of VFx and SDI by summing the grade of deformity for each vertebra were evaluated. At the end of follow-up, the SH(+) group showed a higher prevalence of VFx (81.5%) as compared with baseline (55.6%, p = .04) and a worsening of SDI (2.11 ± 1.85 versus 1.11 ± 1.47, p = .032) associated with SH regardless of age, gender, body mass index , BMD, baseline SDI, menopause duration [odds ratio (OR) = 12.3, 95% confidence interval (CI) 4.1-36.5, p = .001]. The incidence of new vertebral fractures was higher in the SH(+) group (48%) than in the SH(-) group (13%; p = .001). It is concluded that subclinical hypercortisolism is associated with an increased risk of VFx and a possible deterioration of bone quality.
authors.affiliation: Endocrinology and Diabetology Unit, Department of Medical Sciences, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Morelli
authors.forename: Cristina
authors.initials: C
authors.lastname: Eller-Vainicher
authors.forename: Antonio Stefano
authors.initials: AS
authors.lastname: Salcuni
authors.forename: Francesca
authors.initials: F
authors.lastname: Coletti
authors.forename: Laura
authors.initials: L
authors.lastname: Iorio
authors.forename: Giovanna
authors.initials: G
authors.lastname: Muscogiuri
authors.forename: Silvia
authors.initials: S
authors.lastname: Della Casa
authors.forename: Maura
authors.initials: M
authors.lastname: Arosio
authors.forename: Bruno
authors.initials: B
authors.lastname: Ambrosi
authors.forename: Paolo
authors.initials: P
authors.lastname: Beck-Peccoz
authors.forename: Iacopo
authors.initials: I
authors.lastname: Chiodini
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000150:complications*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003480:Cushing Syndrome / Q000150:complications*; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D016103:Spinal Fractures / Q000453:epidemiology* / Q000209:etiology*