Zavatta Guido, Vicennati Valentina, Altieri Paola, Tucci Lorenzo, Colombin Giacomo, Coscia Kimberly, Mosconi Cristina, Balacchi Caterina, Fanelli Flaminia, Malagrinò Matteo, Magagnoli Matteo, Golfieri Rita, Pagotto Uberto, Di Dalmazi Guido
Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy.
Eur J Endocrinol. 2023 Apr 4;188(4):343-352. doi: 10.1093/ejendo/lvad038.
Mild autonomous cortisol secretion (MACS) has been associated with a higher prevalence of osteoporosis, although most data rely on single-center studies with limited sample size. We aimed to assess the prevalence of fragility fractures and contributing factors in a large cohort of patients with adrenal incidentalomas.
Medical records of 1023 patients with adrenal incidentalomas from 1990 to 2019 were reviewed, and 735 patients were selected. Clinically obtained electronic radiological images closest to first endocrine evaluation, such as lateral views of spine X-rays or CT thoraco-abdominal scans, were reviewed to screen for asymptomatic morphometric vertebral fractures. Clinical fragility fractures, hormonal, and dual-energy x-ray absorptiometry (DXA) indices were also recorded.
Four hundred seventy-four patients had nonfunctioning (NF) adrenal incidentalomas, 238 had MACS and 23 adrenal Cushing's syndrome (AC). Prevalence of fragility fractures was different (P = .018) between groups, respectively, 24.1% (NF), 34.0% (MACS), and 30.4% (AC), with significant difference between NF and MACS (P = .012). When analyzed separately by sex and menopausal status, this difference remained significant in postmenopausal women (P = .011), with a fracture prevalence of 22.2% (NF) and 34.6% (MACS). Fracture prevalence was similar in males. Women with MACS aged ≥65 years reported a 48.8% prevalence of fractures, as compared with 29.5% in NF (P < .01). In postmenopausal women, fragility fractures were associated with age (odds ratio [OR] 1.1, P < .001), smoking (OR 1.8, P = .048), and 1 mg-dexamethasone suppression test (DST) cortisol (OR 3.1, P = .029), while in men, only age was associated with fragility fractures.
A considerable fracture burden was shown in postmenopausal women with adrenal incidentalomas and MACS, with clinical implications for the evaluation and management of bone metabolism.
轻度自主性皮质醇分泌（MACS）与骨质疏松症的较高患病率相关，尽管大多数数据依赖于样本量有限的单中心研究。我们旨在评估一大群肾上腺偶发瘤患者中脆性骨折的患病率及其影响因素。
回顾了1990年至2019年1023例肾上腺偶发瘤患者的病历，选取了735例患者。查阅了临床获取的最接近首次内分泌评估的电子放射影像，如脊柱X线侧位片或胸部-腹部CT扫描，以筛查无症状形态计量学椎体骨折。还记录了临床脆性骨折、激素和双能X线吸收测定（DXA）指标。
474例患者患有无功能（NF）肾上腺偶发瘤，238例患有MACS，23例患有肾上腺库欣综合征（AC）。各组间脆性骨折的患病率不同（P = 0.018），分别为24.1%（NF）, 34.0%（MACS）和30.4%（AC），NF与MACS之间存在显著差异（P = 0.012）。按性别和绝经状态分别分析时，这种差异在绝经后女性中仍然显著（P = 0.011），骨折患病率分别为22.2%（NF）和34.6%（MACS）。男性的骨折患病率相似。年龄≥65岁的MACS女性报告骨折患病率为48.8%，而NF女性为29.5%（P < 0.01）。在绝经后女性中，脆性骨折与年龄（比值比[OR] 1.1，P < 0.001）、吸烟（OR 1.8，P = 0.048）和1毫克地塞米松抑制试验（DST）皮质醇（OR 3.1，P = 0.029）相关，而在男性中，只有年龄与脆性骨折相关。
绝经后肾上腺偶发瘤和MACS女性表现出相当大的骨折负担，这对骨代谢的评估和管理具有临床意义。
