title: Prediction of Vertebral Fractures in Patients With Monolateral Adrenal Incidentalomas.
abstract: Subtle hypercortisolism is associated with an increased risk of vertebral fracture (VFx).
  
  
  
  The objective was to determine the best parameters of cortisol secretion for detecting the VFx risk in patients with adrenal incidentalomas (AI).
  
  
  
  This was a retrospective (cross-sectional arm) and prospective (longitudinal arm) design. In the cross-sectional arm, we assessed the accuracy of the cortisol secretion indexes in identifying the patients with VFx (prevalent VFx). In the longitudinal arm, we tested the cortisol secretion parameters, which were able to identify the prevalent VFx, for the prediction of the occurrence of a new VFx (incident VFx) in AI patients followed-up for at least 2 years.
  
  
  
  Four referral Italian endocrinology units participated in this study.
  
  
  
  A total of 444 and 126 AI patients without symptoms of hypercortisolism enrolled in the cross-sectional arm and longitudinal arm, respectively.
  
  
  
  Serum cortisol after a 1-mg dexamethasone suppression test (1 mg DST), urinary free cortisol, ACTH, bone mineral density at lumbar spine and femoral neck (by dual-energy x-ray absorptiometry), and the VFx presence (by x-ray).
  
  
  
  The cortisol levels after 1 mg DST that were greater than 2.0 μg/dl (55 nmol/liter) were the best criteria for detecting patients with both prevalent (73.6% sensitivity, 70.5% specificity) and incident VFx (80% sensitivity, 68.8% specificity) and were associated with a 10-fold increased risk of a new VFx (odds ratio,10.27; 95% confidence interval, 3.39-31.12; P < .0001), regardless of age, gender, bone mineral density at lumbar spine, and prevalent VFx.
  
  
  
  In AI patients without symptoms of overt hypercortisolism, the cortisol levels after 1 mg DST greater than 2.0 μg/dl (55 nmol/liter) represent the best criterion for detecting prevalent and incident VFx.
authors.affiliation: Department of Medical Sciences and Community Health (V.M., S.P., E.C., M.A., A.S.), University of Milan, Milan, Italy; Unit of Endocrinology and Metabolic Diseases (V.M., C.E.-V., S.P., E.C., A.S., I.C.), IRCCS Cà Granda-Ospedale Maggiore Policlinico Milan, Italy; Unit of Endocrinology (A.S.S., A.S.) and Unit of Internal Medicine (V.C.), "Casa Sollievo della Sofferenza," Hospital, IRCCS, San Giovanni Rotondo, Foggia, Italy; Endocrine Unit (A.S.S.), Department of Medical Sciences, University of Cagliari, Italy; Unit of Endocrinology (S.C.), Department of Biomedical Sciences for Health, University of Milan, Policlinico San Donato IRCCS, San Donato Milanese, Milan, Italy; Unit of Endocrine Diseases and Diabetology (M.A.), Ospedale San Giuseppe, Gruppo Multimedica, Milan, Italy; Unit of Endocrinology and Metabolic Diseases (S.D.C., G.M.), Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Morelli
authors.affiliation: Department of Medical Sciences and Community Health (V.M., S.P., E.C., M.A., A.S.), University of Milan, Milan, Italy; Unit of Endocrinology and Metabolic Diseases (V.M., C.E.-V., S.P., E.C., A.S., I.C.), IRCCS Cà Granda-Ospedale Maggiore Policlinico Milan, Italy; Unit of Endocrinology (A.S.S., A.S.) and Unit of Internal Medicine (V.C.), "Casa Sollievo della Sofferenza," Hospital, IRCCS, San Giovanni Rotondo, Foggia, Italy; Endocrine Unit (A.S.S.), Department of Medical Sciences, University of Cagliari, Italy; Unit of Endocrinology (S.C.), Department of Biomedical Sciences for Health, University of Milan, Policlinico San Donato IRCCS, San Donato Milanese, Milan, Italy; Unit of Endocrine Diseases and Diabetology (M.A.), Ospedale San Giuseppe, Gruppo Multimedica, Milan, Italy; Unit of Endocrinology and Metabolic Diseases (S.D.C., G.M.), Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Eller-Vainicher
authors.affiliation: Department of Medical Sciences and Community Health (V.M., S.P., E.C., M.A., A.S.), University of Milan, Milan, Italy; Unit of Endocrinology and Metabolic Diseases (V.M., C.E.-V., S.P., E.C., A.S., I.C.), IRCCS Cà Granda-Ospedale Maggiore Policlinico Milan, Italy; Unit of Endocrinology (A.S.S., A.S.) and Unit of Internal Medicine (V.C.), "Casa Sollievo della Sofferenza," Hospital, IRCCS, San Giovanni Rotondo, Foggia, Italy; Endocrine Unit (A.S.S.), Department of Medical Sciences, University of Cagliari, Italy; Unit of Endocrinology (S.C.), Department of Biomedical Sciences for Health, University of Milan, Policlinico San Donato IRCCS, San Donato Milanese, Milan, Italy; Unit of Endocrine Diseases and Diabetology (M.A.), Ospedale San Giuseppe, Gruppo Multimedica, Milan, Italy; Unit of Endocrinology and Metabolic Diseases (S.D.C., G.M.), Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Serena
authors.initials: S
authors.lastname: Palmieri
authors.affiliation: Department of Medical Sciences and Community Health (V.M., S.P., E.C., M.A., A.S.), University of Milan, Milan, Italy; Unit of Endocrinology and Metabolic Diseases (V.M., C.E.-V., S.P., E.C., A.S., I.C.), IRCCS Cà Granda-Ospedale Maggiore Policlinico Milan, Italy; Unit of Endocrinology (A.S.S., A.S.) and Unit of Internal Medicine (V.C.), "Casa Sollievo della Sofferenza," Hospital, IRCCS, San Giovanni Rotondo, Foggia, Italy; Endocrine Unit (A.S.S.), Department of Medical Sciences, University of Cagliari, Italy; Unit of Endocrinology (S.C.), Department of Biomedical Sciences for Health, University of Milan, Policlinico San Donato IRCCS, San Donato Milanese, Milan, Italy; Unit of Endocrine Diseases and Diabetology (M.A.), Ospedale San Giuseppe, Gruppo Multimedica, Milan, Italy; Unit of Endocrinology and Metabolic Diseases (S.D.C., G.M.), Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Cairoli
authors.affiliation: Department of Medical Sciences and Community Health (V.M., S.P., E.C., M.A., A.S.), University of Milan, Milan, Italy; Unit of Endocrinology and Metabolic Diseases (V.M., C.E.-V., S.P., E.C., A.S., I.C.), IRCCS Cà Granda-Ospedale Maggiore Policlinico Milan, Italy; Unit of Endocrinology (A.S.S., A.S.) and Unit of Internal Medicine (V.C.), "Casa Sollievo della Sofferenza," Hospital, IRCCS, San Giovanni Rotondo, Foggia, Italy; Endocrine Unit (A.S.S.), Department of Medical Sciences, University of Cagliari, Italy; Unit of Endocrinology (S.C.), Department of Biomedical Sciences for Health, University of Milan, Policlinico San Donato IRCCS, San Donato Milanese, Milan, Italy; Unit of Endocrine Diseases and Diabetology (M.A.), Ospedale San Giuseppe, Gruppo Multimedica, Milan, Italy; Unit of Endocrinology and Metabolic Diseases (S.D.C., G.M.), Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Antonio Stefano
authors.initials: AS
authors.lastname: Salcuni
authors.affiliation: Department of Medical Sciences and Community Health (V.M., S.P., E.C., M.A., A.S.), University of Milan, Milan, Italy; Unit of Endocrinology and Metabolic Diseases (V.M., C.E.-V., S.P., E.C., A.S., I.C.), IRCCS Cà Granda-Ospedale Maggiore Policlinico Milan, Italy; Unit of Endocrinology (A.S.S., A.S.) and Unit of Internal Medicine (V.C.), "Casa Sollievo della Sofferenza," Hospital, IRCCS, San Giovanni Rotondo, Foggia, Italy; Endocrine Unit (A.S.S.), Department of Medical Sciences, University of Cagliari, Italy; Unit of Endocrinology (S.C.), Department of Biomedical Sciences for Health, University of Milan, Policlinico San Donato IRCCS, San Donato Milanese, Milan, Italy; Unit of Endocrine Diseases and Diabetology (M.A.), Ospedale San Giuseppe, Gruppo Multimedica, Milan, Italy; Unit of Endocrinology and Metabolic Diseases (S.D.C., G.M.), Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Scillitani
authors.affiliation: Department of Medical Sciences and Community Health (V.M., S.P., E.C., M.A., A.S.), University of Milan, Milan, Italy; Unit of Endocrinology and Metabolic Diseases (V.M., C.E.-V., S.P., E.C., A.S., I.C.), IRCCS Cà Granda-Ospedale Maggiore Policlinico Milan, Italy; Unit of Endocrinology (A.S.S., A.S.) and Unit of Internal Medicine (V.C.), "Casa Sollievo della Sofferenza," Hospital, IRCCS, San Giovanni Rotondo, Foggia, Italy; Endocrine Unit (A.S.S.), Department of Medical Sciences, University of Cagliari, Italy; Unit of Endocrinology (S.C.), Department of Biomedical Sciences for Health, University of Milan, Policlinico San Donato IRCCS, San Donato Milanese, Milan, Italy; Unit of Endocrine Diseases and Diabetology (M.A.), Ospedale San Giuseppe, Gruppo Multimedica, Milan, Italy; Unit of Endocrinology and Metabolic Diseases (S.D.C., G.M.), Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Carnevale
authors.affiliation: Department of Medical Sciences and Community Health (V.M., S.P., E.C., M.A., A.S.), University of Milan, Milan, Italy; Unit of Endocrinology and Metabolic Diseases (V.M., C.E.-V., S.P., E.C., A.S., I.C.), IRCCS Cà Granda-Ospedale Maggiore Policlinico Milan, Italy; Unit of Endocrinology (A.S.S., A.S.) and Unit of Internal Medicine (V.C.), "Casa Sollievo della Sofferenza," Hospital, IRCCS, San Giovanni Rotondo, Foggia, Italy; Endocrine Unit (A.S.S.), Department of Medical Sciences, University of Cagliari, Italy; Unit of Endocrinology (S.C.), Department of Biomedical Sciences for Health, University of Milan, Policlinico San Donato IRCCS, San Donato Milanese, Milan, Italy; Unit of Endocrine Diseases and Diabetology (M.A.), Ospedale San Giuseppe, Gruppo Multimedica, Milan, Italy; Unit of Endocrinology and Metabolic Diseases (S.D.C., G.M.), Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Corbetta
authors.affiliation: Department of Medical Sciences and Community Health (V.M., S.P., E.C., M.A., A.S.), University of Milan, Milan, Italy; Unit of Endocrinology and Metabolic Diseases (V.M., C.E.-V., S.P., E.C., A.S., I.C.), IRCCS Cà Granda-Ospedale Maggiore Policlinico Milan, Italy; Unit of Endocrinology (A.S.S., A.S.) and Unit of Internal Medicine (V.C.), "Casa Sollievo della Sofferenza," Hospital, IRCCS, San Giovanni Rotondo, Foggia, Italy; Endocrine Unit (A.S.S.), Department of Medical Sciences, University of Cagliari, Italy; Unit of Endocrinology (S.C.), Department of Biomedical Sciences for Health, University of Milan, Policlinico San Donato IRCCS, San Donato Milanese, Milan, Italy; Unit of Endocrine Diseases and Diabetology (M.A.), Ospedale San Giuseppe, Gruppo Multimedica, Milan, Italy; Unit of Endocrinology and Metabolic Diseases (S.D.C., G.M.), Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Maura
authors.initials: M
authors.lastname: Arosio
authors.affiliation: Department of Medical Sciences and Community Health (V.M., S.P., E.C., M.A., A.S.), University of Milan, Milan, Italy; Unit of Endocrinology and Metabolic Diseases (V.M., C.E.-V., S.P., E.C., A.S., I.C.), IRCCS Cà Granda-Ospedale Maggiore Policlinico Milan, Italy; Unit of Endocrinology (A.S.S., A.S.) and Unit of Internal Medicine (V.C.), "Casa Sollievo della Sofferenza," Hospital, IRCCS, San Giovanni Rotondo, Foggia, Italy; Endocrine Unit (A.S.S.), Department of Medical Sciences, University of Cagliari, Italy; Unit of Endocrinology (S.C.), Department of Biomedical Sciences for Health, University of Milan, Policlinico San Donato IRCCS, San Donato Milanese, Milan, Italy; Unit of Endocrine Diseases and Diabetology (M.A.), Ospedale San Giuseppe, Gruppo Multimedica, Milan, Italy; Unit of Endocrinology and Metabolic Diseases (S.D.C., G.M.), Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Della Casa
authors.affiliation: Department of Medical Sciences and Community Health (V.M., S.P., E.C., M.A., A.S.), University of Milan, Milan, Italy; Unit of Endocrinology and Metabolic Diseases (V.M., C.E.-V., S.P., E.C., A.S., I.C.), IRCCS Cà Granda-Ospedale Maggiore Policlinico Milan, Italy; Unit of Endocrinology (A.S.S., A.S.) and Unit of Internal Medicine (V.C.), "Casa Sollievo della Sofferenza," Hospital, IRCCS, San Giovanni Rotondo, Foggia, Italy; Endocrine Unit (A.S.S.), Department of Medical Sciences, University of Cagliari, Italy; Unit of Endocrinology (S.C.), Department of Biomedical Sciences for Health, University of Milan, Policlinico San Donato IRCCS, San Donato Milanese, Milan, Italy; Unit of Endocrine Diseases and Diabetology (M.A.), Ospedale San Giuseppe, Gruppo Multimedica, Milan, Italy; Unit of Endocrinology and Metabolic Diseases (S.D.C., G.M.), Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Muscogiuri
authors.affiliation: Department of Medical Sciences and Community Health (V.M., S.P., E.C., M.A., A.S.), University of Milan, Milan, Italy; Unit of Endocrinology and Metabolic Diseases (V.M., C.E.-V., S.P., E.C., A.S., I.C.), IRCCS Cà Granda-Ospedale Maggiore Policlinico Milan, Italy; Unit of Endocrinology (A.S.S., A.S.) and Unit of Internal Medicine (V.C.), "Casa Sollievo della Sofferenza," Hospital, IRCCS, San Giovanni Rotondo, Foggia, Italy; Endocrine Unit (A.S.S.), Department of Medical Sciences, University of Cagliari, Italy; Unit of Endocrinology (S.C.), Department of Biomedical Sciences for Health, University of Milan, Policlinico San Donato IRCCS, San Donato Milanese, Milan, Italy; Unit of Endocrine Diseases and Diabetology (M.A.), Ospedale San Giuseppe, Gruppo Multimedica, Milan, Italy; Unit of Endocrinology and Metabolic Diseases (S.D.C., G.M.), Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Spada
authors.affiliation: Department of Medical Sciences and Community Health (V.M., S.P., E.C., M.A., A.S.), University of Milan, Milan, Italy; Unit of Endocrinology and Metabolic Diseases (V.M., C.E.-V., S.P., E.C., A.S., I.C.), IRCCS Cà Granda-Ospedale Maggiore Policlinico Milan, Italy; Unit of Endocrinology (A.S.S., A.S.) and Unit of Internal Medicine (V.C.), "Casa Sollievo della Sofferenza," Hospital, IRCCS, San Giovanni Rotondo, Foggia, Italy; Endocrine Unit (A.S.S.), Department of Medical Sciences, University of Cagliari, Italy; Unit of Endocrinology (S.C.), Department of Biomedical Sciences for Health, University of Milan, Policlinico San Donato IRCCS, San Donato Milanese, Milan, Italy; Unit of Endocrine Diseases and Diabetology (M.A.), Ospedale San Giuseppe, Gruppo Multimedica, Milan, Italy; Unit of Endocrinology and Metabolic Diseases (S.D.C., G.M.), Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Iacopo
authors.initials: I
authors.lastname: Chiodini
mesh_terms: D015502:Absorptiometry, Photon; D000310:Adrenal Gland Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000378:metabolism; D000308:Adrenocortical Hyperfunction / Q000150:complications* / Q000175:diagnosis / Q000378:metabolism; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D003430:Cross-Sectional Studies; D005260:Female; D005272:Femur Neck; D006801:Humans; D006854:Hydrocortisone / Q000097:blood* / Q000378:metabolism; D008137:Longitudinal Studies; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D055815:Young Adult
chemical_list: D006854:Hydrocortisone