Objective: Subclinical hypercortisolism (SH) is associated with increased risk of vertebral fractures (VFx). The effect on bone following recovery from SH is unknown. Design: 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)O5.0 mg/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 (DZ-score/year) tended to increase in the surgical group (0.10±0.20) compared with the non-surgical group (K0.01±0.27, PZ0.08) 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, PZ0.008) regardless of age, gender, follow up duration, 1 mg-DST, LS BMD, and presence of VFx at baseline. Conclusion: In patients with monolateral AI and SH, adrenalectomy reduces the risk of VFx.
Adrenalectomy reduces the risk of vertebral fractures in patients with monolateral adrenal incidentalomas and subclinical hypercortisolism / A.S. Salcuni, V. Morelli, C.E. Vainicher, S. Palmieri, E. Cairoli, A. Spada, A. Scillitani, I. Chiodini. - In: EUROPEAN JOURNAL OF ENDOCRINOLOGY. - ISSN 0804-4643. - 174:3(2016 Mar), pp. 261-269.
Adrenalectomy reduces the risk of vertebral fractures in patients with monolateral adrenal incidentalomas and subclinical hypercortisolism
V. MorelliSecondo
;C.E. Vainicher;S. Palmieri;E. Cairoli;I. Chiodini
Ultimo
2016
Abstract
Objective: Subclinical hypercortisolism (SH) is associated with increased risk of vertebral fractures (VFx). The effect on bone following recovery from SH is unknown. Design: 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)O5.0 mg/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 (DZ-score/year) tended to increase in the surgical group (0.10±0.20) compared with the non-surgical group (K0.01±0.27, PZ0.08) 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, PZ0.008) regardless of age, gender, follow up duration, 1 mg-DST, LS BMD, and presence of VFx at baseline. Conclusion: In patients with monolateral AI and SH, adrenalectomy reduces the risk of VFx.File | Dimensione | Formato | |
---|---|---|---|
90 - Adrenalectomy reduces the risk of vertebral fractures in patients with monolateral adrenal - EJE 2016.pdf
accesso riservato
Tipologia:
Altro
Dimensione
164.79 kB
Formato
Adobe PDF
|
164.79 kB | Adobe PDF | Visualizza/Apri Richiedi una copia |
[1479683X - European Journal of Endocrinology] Adrenalectomy reduces the risk of vertebral fractures.pdf
accesso riservato
Tipologia:
Publisher's version/PDF
Dimensione
205.31 kB
Formato
Adobe PDF
|
205.31 kB | Adobe PDF | Visualizza/Apri Richiedi una copia |
Pubblicazioni consigliate
I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.