Moraes Aline Barbosa, de Paula Marcela Pessoa, de Paula Paranhos-Neto Francisco, Cavalari Emanuela Mello Ribeiro, de Morais Felipe Fernandes Cordeiro, Curi Daniel Silva Carvalho, Lima Luis Felipe Cardoso, de Mendonça Laura Maria Carvalho, Farias Maria Lucia Fleiuss, Madeira Miguel, Vieira Neto Leonardo
Department of Internal Medicine and Endocrine Unit, Federal University of Rio de Janeiro, School of Medicine, Clementino Fraga Filho University Hospital, Rio de Janeiro, RJ, Brazil.
Nuclear Instrumentation Laboratory, COPPE-PEN, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
J Clin Endocrinol Metab. 2020 Aug 1;105(8). doi: 10.1210/clinem/dgaa263.
Data regarding high-resolution peripheral quantitative computed tomography (HR-pQCT) in patients with adrenal incidentaloma (AI) are unknown.
To evaluate the areal bone mineral density (aBMD), microstructure, and fractures in patients with nonfunctioning AI (NFAI) and autonomous cortisol secretion (ACS).
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.
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).
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.
关于肾上腺偶发瘤（AI）患者的高分辨率外周定量计算机断层扫描（HR-pQCT）数据尚不清楚。
评估无功能肾上腺偶发瘤（NFAI）和自主性皮质醇分泌（ACS）患者的骨面积密度（aBMD）、微观结构和骨折情况。
我们评估了45例NFAI患者（1毫克地塞米松抑制试验[DST]≤1.8微克/分升）和30例ACS患者（1毫克DST为1.9 - 5.0微克/分升）。使用双能X线吸收法测量aBMD；通过脊柱X线检查椎体骨折；通过HR-pQCT测量骨几何形状、骨体积密度（vBMD）和微观结构。
ACS患者在脊柱、股骨颈和桡骨处的aBMD值比NFAI患者低33%。两组骨质疏松症都很常见：NFAI组（64.9%）和ACS组（75%）。与NFAI患者相比，ACS患者通过HR-pQCT测量的桡骨远端参数降低：骨小梁vBMD（Tb.vBMD，P = 0.03）、骨小梁区域内区（Inn.Tb.vBMD，P = 0.01）、骨体积/组织体积比（BV/TV，P = 0.03）和骨小梁厚度（P = 0.04）。因此，观察到骨小梁区域外区/内区vBMD的比率更高（Meta/Inn.vBMD，P = 0.003）。发现1毫克DST后的皮质醇水平与Meta/Inn.vBMD比率之间存在相关性（r = 0.29；P = 0.01）。ACS患者的骨折频率为73.7%，而NFAI患者为55.6%（P = 0.24）。
我们的研究结果表明桡骨远端骨小梁微结构紊乱与ACS之间存在关联。我们的数据表明，通过HR-pQCT评估时，AI对骨骼有负面影响，可能与亚临床皮质醇增多症有关。
