The Journal of Clinical Endocrinology and Metabolism Journal Article

Bone Study in Patients With Adrenal Incidentaloma

August 24, 2020
 

Aline Barbosa Moraes, Marcela Pessoa de Paula, Francisco de Paula Paranhos-Neto, Emanuela Mello Ribeiro Cavalari, Felipe Fernandes Cordeiro de Morais, Daniel Silva Carvalho Curi, Luis Felipe Cardoso Lima, Laura Maria Carvalho de Mendonça, Maria Lucia Fleiuss Farias, Miguel Madeira, Leonardo Vieira Neto
The Journal of Clinical Endocrinology & Metabolism, Volume 105, Issue 8, August 2020, dgaa263
https://doi.org/10.1210/clinem/dgaa263

Abstract

Context

Data regarding high-resolution peripheral quantitative computed tomography (HR-pQCT) in patients with adrenal incidentaloma (AI) are unknown.

Purpose

To evaluate the areal bone mineral density (aBMD), microstructure, and fractures in patients with nonfunctioning AI (NFAI) and autonomous cortisol secretion (ACS).

Methods

We evaluated 45 patients with NFAI (1 mg dexamethasone suppression test [DST] ≤1.8 µg/dL) and 30 patients with ACS (1 mg DST 1.9–5.0 µg/dL). aBMD was measured using dual-energy X-ray absorptiometry; vertebral fracture by spine X-ray; and bone geometry, volumetric bone mineral density (vBMD), and microstructure by HR-pQCT.

Results

Patients with ACS showed lower aBMD values at the spine, femoral neck, and radius 33% than those with NFAI. Osteoporosis was frequent in both groups: NFAI (64.9%) and ACS (75%). Parameters at the distal radius by HR-pQCT were decreased in patients with ACS compared to those with NFAI: trabecular vBMD (Tb.vBMD, P = 0.03), inner zone of the trabecular region (Inn.Tb.vBMD, P = 0.01), the bone volume/tissue volume ratio (BV/TV, P = 0.03) and trabecular thickness (P = 0.04). As consequence, a higher ratio of the outer zone of the trabecular region/inner zone vBMD (Meta/Inn.vBMD, P = 0.003) was observed. A correlation between the cortisol levels after 1 mg DST and Meta/Inn.vBMD ratio was found (r = 0.29; P = 0.01). The fracture frequency was 73.7% in patients with ACS vs 55.6% in patients with NFAI (P = 0.24).

Conclusion

Our findings point to an association between trabecular bone microarchitectural derangement at the distal radius and ACS. Our data suggest that AI have a negative impact on bone when assessed by HR-pQCT, probably associated to subclinical hypercortisolism.

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