title: Adrenalectomy reduces the risk of vertebral fractures in patients with monolateral adrenal incidentalomas and subclinical hypercortisolism.
abstract: OBJECTIVE
  Subclinical hypercortisolism (SH) is associated with increased risk of vertebral fractures (VFx). The effect on bone following recovery from SH is unknown.
  
  
  METHODS
  Of the 605 subjects consecutively referred for monolateral adrenal incidentalomas (AIs) to our outpatient clinics, 55 SH patients (recruited on the basis of the exclusion criteria) were enrolled. We suggested to all patients to undergo adrenalectomy, which was accepted by 32 patients (surgical group, age 61.3±8.1 years) and refused by 23 patients, who were followed with a conservative management (non-surgical group, age 65.4±7.1 years).
  
  
  METHODS
  We diagnosed SH in patients with serum cortisol after 1  mg dexamethasone suppression test (1  mg-DST) >5.0  μg/dl or with greater than or equal to two criteria among 1  mg-DST >3.0  μg/dl, urinary free cortisol >70  μg/24  h and ACTH <10  pg/ml. We assessed: bone mineral density (BMD) at lumbar spine (LS) and femoral neck (as Z-score) by dual-energy X-ray absorptiometry and the VFx presence by X-ray at baseline and at the end of follow up (surgical group 39.9±20.9 months and non-surgical group 27.7±11.1 months).
  
  
  RESULTS
  The LS Z-score (ΔZ-score/year) tended to increase in the surgical group (0.10±0.20) compared with the non-surgical group (-0.01±0.27, P=0.08) and in the former, the percentage of patients with new VFx was lower (9.4%) than in the latter (52.2%, P<0.0001). Surgery in AI patients with SH was associated with a 30% VFx risk reduction (odds ratio 0.7, 95% CI 0.01-0.05, P=0.008) regardless of age, gender, follow up duration, 1  mg-DST, LS BMD, and presence of VFx at baseline.
  
  
  CONCLUSIONS
  In patients with monolateral AI and SH, adrenalectomy reduces the risk of VFx.
authors.affiliation: Unit of Endocrinology'Casa Sollievo della Sofferenza' Hospital, IRCCS, San Giovanni Rotondo, Foggia, ItalyEndocrine UnitDepartment of Medical Sciences, University of Cagliari, Cagliari, ItalyUnit of Endocrinology and Metabolic DiseasesPadiglione Granelli, Fondazione IRCCS Cà-Granda-Ospedale Maggiore Policlinico, Milan, ItalyDepartment of Medical Sciences and Community HealthUniversity of Milan, Milan, Italy Unit of Endocrinology'Casa Sollievo della Sofferenza' Hospital, IRCCS, San Giovanni Rotondo, Foggia, ItalyEndocrine UnitDepartment of Medical Sciences, University of Cagliari, Cagliari, ItalyUnit of Endocrinology and Metabolic DiseasesPadiglione Granelli, Fondazione IRCCS Cà-Granda-Ospedale Maggiore Policlinico, Milan, ItalyDepartment of Medical Sciences and Community HealthUniversity of Milan, Milan, Italy.
authors.forename: Antonio Stefano
authors.initials: AS
authors.lastname: Salcuni
authors.affiliation: Unit of Endocrinology'Casa Sollievo della Sofferenza' Hospital, IRCCS, San Giovanni Rotondo, Foggia, ItalyEndocrine UnitDepartment of Medical Sciences, University of Cagliari, Cagliari, ItalyUnit of Endocrinology and Metabolic DiseasesPadiglione Granelli, Fondazione IRCCS Cà-Granda-Ospedale Maggiore Policlinico, Milan, ItalyDepartment of Medical Sciences and Community HealthUniversity of Milan, Milan, Italy Unit of Endocrinology'Casa Sollievo della Sofferenza' Hospital, IRCCS, San Giovanni Rotondo, Foggia, ItalyEndocrine UnitDepartment of Medical Sciences, University of Cagliari, Cagliari, ItalyUnit of Endocrinology and Metabolic DiseasesPadiglione Granelli, Fondazione IRCCS Cà-Granda-Ospedale Maggiore Policlinico, Milan, ItalyDepartment of Medical Sciences and Community HealthUniversity of Milan, Milan, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Morelli
authors.affiliation: Unit of Endocrinology'Casa Sollievo della Sofferenza' Hospital, IRCCS, San Giovanni Rotondo, Foggia, ItalyEndocrine UnitDepartment of Medical Sciences, University of Cagliari, Cagliari, ItalyUnit of Endocrinology and Metabolic DiseasesPadiglione Granelli, Fondazione IRCCS Cà-Granda-Ospedale Maggiore Policlinico, Milan, ItalyDepartment of Medical Sciences and Community HealthUniversity of Milan, Milan, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Eller Vainicher
authors.affiliation: Unit of Endocrinology'Casa Sollievo della Sofferenza' Hospital, IRCCS, San Giovanni Rotondo, Foggia, ItalyEndocrine UnitDepartment of Medical Sciences, University of Cagliari, Cagliari, ItalyUnit of Endocrinology and Metabolic DiseasesPadiglione Granelli, Fondazione IRCCS Cà-Granda-Ospedale Maggiore Policlinico, Milan, ItalyDepartment of Medical Sciences and Community HealthUniversity of Milan, Milan, Italy Unit of Endocrinology'Casa Sollievo della Sofferenza' Hospital, IRCCS, San Giovanni Rotondo, Foggia, ItalyEndocrine UnitDepartment of Medical Sciences, University of Cagliari, Cagliari, ItalyUnit of Endocrinology and Metabolic DiseasesPadiglione Granelli, Fondazione IRCCS Cà-Granda-Ospedale Maggiore Policlinico, Milan, ItalyDepartment of Medical Sciences and Community HealthUniversity of Milan, Milan, Italy.
authors.forename: Serena
authors.initials: S
authors.lastname: Palmieri
authors.affiliation: Unit of Endocrinology'Casa Sollievo della Sofferenza' Hospital, IRCCS, San Giovanni Rotondo, Foggia, ItalyEndocrine UnitDepartment of Medical Sciences, University of Cagliari, Cagliari, ItalyUnit of Endocrinology and Metabolic DiseasesPadiglione Granelli, Fondazione IRCCS Cà-Granda-Ospedale Maggiore Policlinico, Milan, ItalyDepartment of Medical Sciences and Community HealthUniversity of Milan, Milan, Italy Unit of Endocrinology'Casa Sollievo della Sofferenza' Hospital, IRCCS, San Giovanni Rotondo, Foggia, ItalyEndocrine UnitDepartment of Medical Sciences, University of Cagliari, Cagliari, ItalyUnit of Endocrinology and Metabolic DiseasesPadiglione Granelli, Fondazione IRCCS Cà-Granda-Ospedale Maggiore Policlinico, Milan, ItalyDepartment of Medical Sciences and Community HealthUniversity of Milan, Milan, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Cairoli
authors.affiliation: Unit of Endocrinology'Casa Sollievo della Sofferenza' Hospital, IRCCS, San Giovanni Rotondo, Foggia, ItalyEndocrine UnitDepartment of Medical Sciences, University of Cagliari, Cagliari, ItalyUnit of Endocrinology and Metabolic DiseasesPadiglione Granelli, Fondazione IRCCS Cà-Granda-Ospedale Maggiore Policlinico, Milan, ItalyDepartment of Medical Sciences and Community HealthUniversity of Milan, Milan, Italy Unit of Endocrinology'Casa Sollievo della Sofferenza' Hospital, IRCCS, San Giovanni Rotondo, Foggia, ItalyEndocrine UnitDepartment of Medical Sciences, University of Cagliari, Cagliari, ItalyUnit of Endocrinology and Metabolic DiseasesPadiglione Granelli, Fondazione IRCCS Cà-Granda-Ospedale Maggiore Policlinico, Milan, ItalyDepartment of Medical Sciences and Community HealthUniversity of Milan, Milan, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Spada
authors.affiliation: Unit of Endocrinology'Casa Sollievo della Sofferenza' Hospital, IRCCS, San Giovanni Rotondo, Foggia, ItalyEndocrine UnitDepartment of Medical Sciences, University of Cagliari, Cagliari, ItalyUnit of Endocrinology and Metabolic DiseasesPadiglione Granelli, Fondazione IRCCS Cà-Granda-Ospedale Maggiore Policlinico, Milan, ItalyDepartment of Medical Sciences and Community HealthUniversity of Milan, Milan, Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Scillitani
authors.affiliation: Unit of Endocrinology'Casa Sollievo della Sofferenza' Hospital, IRCCS, San Giovanni Rotondo, Foggia, ItalyEndocrine UnitDepartment of Medical Sciences, University of Cagliari, Cagliari, ItalyUnit of Endocrinology and Metabolic DiseasesPadiglione Granelli, Fondazione IRCCS Cà-Granda-Ospedale Maggiore Policlinico, Milan, ItalyDepartment of Medical Sciences and Community HealthUniversity of Milan, Milan, Italy iacopo.chiodini@policlinico.mi.it.
authors.forename: Iacopo
authors.initials: I
authors.lastname: Chiodini
mesh_terms: D015502:Absorptiometry, Photon; D000310:Adrenal Gland Neoplasms / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D000315:Adrenalectomy; D000328:Adult; D000368:Aged; D058070:Asymptomatic Diseases; D015519:Bone Density; D003480:Cushing Syndrome / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D005260:Female; D005272:Femur Neck / Q000000981:diagnostic imaging*; D006801:Humans; D016015:Logistic Models; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D016103:Spinal Fractures / Q000453:epidemiology*; D016896:Treatment Outcome