title: Bilateral and unilateral adrenal incidentalomas: biochemical and clinical characteristics.
abstract: OBJECTIVE
  The possible different prevalence of arterial hypertension (AH), type 2 diabetes mellitus (T2DM), dyslipidaemia (DL) and vertebral fractures (FX) between patients with bilateral and unilateral adrenal incidentalomas (BAI and UAI, respectively) with and without subclinical hypercortisolism (SH) is unknown. In this study we compared the prevalence of AH, T2DM, DL and FX in BAI and UAI patients in relation to SH.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  In 175 UAI and 38 BAI patients, we evaluated BMI, spinal and femoral bone mineral density (LS and FN BMD, respectively) and the presence of AH, T2DM, DL and FX. SH was diagnosed in the presence of 2 of the following: urinary free cortisol levels >193 nmol/24 h, serum cortisol levels after 1 mg dexamethasone suppression test >83 nmol/l or ACTH levels <2.2 pmol/l.
  
  
  RESULTS
  Age, BMI and cortisol secretion were comparable, while FN BMD was lower in BAI than in UAI patients (-0.45±0.86 vs 0.09±1.07, P=0.004). The prevalence of SH, AH, T2DM, and DL was comparable, while the prevalence of FX was higher in BAI than in UAI (52.6 vs 28%, P=0.007). The presence of FX was associated with BAI (odds ratio (OR) 2.6, 95% confidence interval (95% CI) 1.2-5.6, P=0.016), after adjusting for SH (OR 1.77, 95% CI 0.85-3.7, P=0.12), BMI (OR 1.06, 95% CI 0.98-1.13, P=0.1), age (OR 1.07, 95% CI 1.04-1.11, P=0.0001) and LS BMD (OR 1.31, 95% CI 1.03-1.67, P=0.03).
  
  
  CONCLUSIONS
  BAI patients have an increased FX risk than UAI ones. Further studies should investigate the causes of bone involvement in BAI patients.
authors.affiliation: Endocrinology and Diabetology Unit, Department of Clinical Sciences and Community Health, University of Milan, Fondazione IRCCS Cà Granda - Ospedale Maggiore Policlinico, Padiglione Granelli, Via Francesco Sforza 35, 20122 Milan, Italy. morellivale@yahoo.it
authors.forename: V
authors.initials: V
authors.lastname: Morelli
authors.forename: S
authors.initials: S
authors.lastname: Palmieri
authors.forename: A S
authors.initials: AS
authors.lastname: Salcuni
authors.forename: C
authors.initials: C
authors.lastname: Eller-Vainicher
authors.forename: E
authors.initials: E
authors.lastname: Cairoli
authors.forename: V
authors.initials: V
authors.lastname: Zhukouskaya
authors.forename: A
authors.initials: A
authors.lastname: Scillitani
authors.forename: P
authors.initials: P
authors.lastname: Beck-Peccoz
authors.forename: I
authors.initials: I
authors.lastname: Chiodini
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000453:epidemiology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D015519:Bone Density / Q000502:physiology; D003480:Cushing Syndrome / Q000175:diagnosis / Q000453:epidemiology* / Q000652:urine; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D050171:Dyslipidemias / Q000453:epidemiology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D011446:Prospective Studies; D016103:Spinal Fractures / Q000453:epidemiology*