Chiodini Iacopo, Viti Raffaella, Coletti Francesca, Guglielmi Giuseppe, Battista Claudia, Ermetici Federica, Morelli Valentina, Salcuni Antonio, Carnevale Vincenzo, Urbano Filomena, Muscarella Silvana, Ambrosi Bruno, Arosio Maura, Beck-Peccoz Paolo, Scillitani Alfredo
Department of Medical Sciences, University of Milan, Endocrinology and Diabetology Unit, Fondazione Policlinico, Mangiagalli e Regina Elena, IRCCS, Milan, Italy.
Clin Endocrinol (Oxf). 2009 Feb;70(2):208-13. doi: 10.1111/j.1365-2265.2008.03310.x. Epub 2008 Jun 10.
Subclinical hypercortisolism (SH) is suggested to exert a deleterious effect on bone. This effect and the role of gonadal status in male subjects are not fully elucidated. We evaluated bone mineral density (BMD) and prevalence of vertebral fractures in eugonadal male subjects with adrenal incidentalomas (AI) and without SH.
This 12-month observational multicentre study was performed between January and December 2006 on inpatient basis in three referral Italian centres.
Eighty-eight consecutive eugonadal male patients with AI and 90 matched control subjects were studied.
All subjects underwent the determination of BMD by dual-energy X-ray absorptiometry at lumbar spine (LS) and femoral neck (FN), and spinal radiograph. In AI patients SH was diagnosed in the presence of two of the following: urinary free cortisol > 193.1 nmol/l, cortisol after 1 mg dexamethasone suppression test > 82.8 nmol/l, ACTH levels < 2.2 pmol/l.
As compared to patients without SH (SH-, n = 66) and controls, patients with SH (SH+, n = 22) had lower BMD at LS (Z-score: SH+, -1.04 +/- 1.84; SH-, 0.19 +/- 1.34, Controls 0.20 +/- 1.28, P = 0.001 and FN (Z-score: SH+, -0.63 +/- 1.01; SH-, 0.01 +/- 1.01, Controls 0.26 +/- 1.06, P = 0.002) and higher prevalence of fractures (SH+, 72.7%; SH-, 21.2%, Controls 20.0%, P = 0.0001). Multivariable analyses showed that SH was associated to BMD at LS (beta = -0.378, P = 0.0001) and vertebral fractures (OR = 7.81, 95% CI 1.96-31.17, P = 0.004).
In eugonadal male patients with AI, SH is associated with low BMD and high prevalence of vertebral fractures.
亚临床皮质醇增多症（SH）被认为会对骨骼产生有害影响。这种影响以及性腺状态在男性受试者中的作用尚未完全阐明。我们评估了性腺功能正常的肾上腺偶发瘤（AI）男性受试者且无SH者的骨密度（BMD）和椎体骨折患病率。
这项为期12个月的观察性多中心研究于2006年1月至12月在意大利三个转诊中心的住院患者中进行。
对88例连续的性腺功能正常的AI男性患者和90例匹配的对照受试者进行了研究。
所有受试者均通过双能X线吸收法测定腰椎（LS）和股骨颈（FN）的骨密度，并进行脊柱X线摄影。在AI患者中，若出现以下两项情况则诊断为SH：尿游离皮质醇>193.1 nmol/l，1 mg地塞米松抑制试验后皮质醇>82.8 nmol/l，促肾上腺皮质激素（ACTH）水平<2.2 pmol/l。
与无SH的患者（SH-，n = 66）和对照组相比，有SH的患者（SH+，n = 22）的腰椎骨密度较低（Z评分：SH+，-1.04±1.84；SH-，0.19±1.34，对照组0.20±1.28，P = 0.001）和股骨颈骨密度较低（Z评分：SH+，-0.63±1.01；SH-，0.01±1.01，对照组0.26±1.06，P = 0.002），骨折患病率较高（SH+，72.7%；SH-，21.2%，对照组20.0%，P = 0.0001）。多变量分析显示，SH与腰椎骨密度（β=-0.378，P = 0.0001）和椎体骨折（OR = 7.81，95%CI 1.96 - 31.17，P = 0.004）相关。
在性腺功能正常的AI男性患者中，SH与低骨密度和高椎体骨折患病率相关。
