Osella G, Reimondo G, Peretti P, Alì A, Paccotti P, Angeli A, Terzolo M
Dipartimento di Scienze Cliniche e Biologiche, Medicina Interna I, A. O. San Luigi, 10043 Orbassano, Torino, Italy.
J Clin Endocrinol Metab. 2001 Feb;86(2):604-7. doi: 10.1210/jcem.86.2.7178.
The main problem in the management of the patients with incidentally discovered adrenal mass (incidentaloma) is whether and when the incidental mass puts the patient at increased risk for an adverse outcome. As osteoporosis is a well known complication of endogenous and exogenous glucocorticoid excess, it is likely that patients with incidentally discovered adrenocortical adenomas have impaired bone mass due to subclinical hypercortisolism. We measured spinal bone mineral density (BMD) by dual energy x-ray absorptiometry in 27 patients (9 men and 18 women) and 54 healthy subjects (18 men and 36 women) carefully matched for age, sex, body mass index, and menstrual status for a case-control analysis. BMD was also measured at the hip in the group of patients. A multiple regression analysis was performed to determine which biochemical variables might influence BMD values. Lumbar BMD values in patients with adrenal incidentaloma were not significantly different from those in control subjects (BMD, 0.926, 0.604--1.144 vs. 0.936, 0.645--1.268 g/cm(2); P = NS). No significant difference in lumbar and femoral BMD was found between patients with or without subclinical Cushing's syndrome. Among the variables processed, only PTH remained in the final model and was inversely correlated with lumbar spine and femoral neck BMD values (r = -0.5; r(2) = 0.25; P = 0.015 and r = -0.42; r(2) = 0.18; P = 0.03, respectively). In conclusion, our data do not suggest that the slight glucocorticoid excess associated with adrenal incidentaloma increases the risk of osteoporosis. The evaluation of BMD does not seem to be crucial in the management of incidentally discovered adrenal masses.
偶然发现肾上腺肿块（偶发瘤）患者管理中的主要问题是该偶然肿块是否以及何时会使患者出现不良结局的风险增加。由于骨质疏松是内源性和外源性糖皮质激素过多的一种众所周知的并发症，因此偶然发现肾上腺皮质腺瘤的患者可能因亚临床皮质醇增多症而导致骨量受损。我们采用双能X线吸收法测量了27例患者（9名男性和18名女性）以及54名健康受试者（18名男性和36名女性）的脊柱骨密度，这些健康受试者在年龄、性别、体重指数和月经状态方面经过精心匹配，以进行病例对照分析。还对患者组的髋部骨密度进行了测量。进行多元回归分析以确定哪些生化变量可能影响骨密度值。肾上腺偶发瘤患者的腰椎骨密度值与对照组无显著差异（骨密度，0.926，0.604 - 1.144 vs. 0.936，0.645 - 1.268 g/cm²；P = 无显著差异）。有或无亚临床库欣综合征的患者在腰椎和股骨骨密度方面未发现显著差异。在处理的变量中，只有甲状旁腺激素保留在最终模型中，并且与腰椎和股骨颈骨密度值呈负相关（r = -0.5；r² = 0.25；P = 0.015以及r = -0.42；r² = 0.18；P = 0.03）。总之，我们的数据并不表明与肾上腺偶发瘤相关的轻微糖皮质激素过多会增加骨质疏松的风险。骨密度评估在偶然发现肾上腺肿块的管理中似乎并非至关重要。
