Favero Vittoria, Cairoli Elisa, Eller-Vainicher Cristina, Morelli Valentina, Salcuni Antonio Stefano, Della Casa Silvia, Muscogiuri Giovanna, Columbu Carla, Pugliese Flavia, Corbetta Sabrina, Persani Luca, Scillitani Alfredo, Chiodini Iacopo
Department of Medical Biotechnology and Translational Medicine, University of Milan, 20100 Milan, Italy.
UOSD Bone Metabolic Diseases and Diabetes, Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, 20100 Milan, Italy.
J Endocr Soc. 2024 Aug 16;8(10):bvae144. doi: 10.1210/jendso/bvae144. eCollection 2024 Aug 27.
The risk of vertebral fractures (VFx) in patients with nonfunctioning adrenal incidentalomas (NFAI) is unknown.
This work aimed to assess in NFAI patients the prevalence and incidence of VFx and a hormonal marker to identify patients at risk.
A retrospective, cross-sectional, and longitudinal study of outpatients was conducted. A total of 306 NFAI patients (cross-sectional arm) and 213 controls were evaluated for VFx prevalence; 85 NFAI patients (longitudinal arm, follow-up 30.3 ± 17.5 months) were evaluated for VFx incidence. Main outcome measures included serum cortisol after 1 mg-dexamethasone test (F-1mgDST), lumbar spinal (LS), and femoral neck (FN) bone mineral density (BMD) and VFx presence, by radiograph of the spine.
Cross-sectional arm: prevalent VFx associated with F-1mgDST with a cutoff of 1.2 µg/dL (33 nmol/L, area under the curve 0.620 ± 0.39; = .002). Compared with controls and NFAI patients with F-1mgDST less than 1.2 µg/dL (group A), NFAI patients with F-1mgDST greater than or equal to 1.2 µg/dL (group B) showed a higher VFx prevalence (10.8%, 12.6%, and 29.5%, respectively; < .001 all comparisons), which was associated with F-1mgDST greater than or equal to 1.2 µg/dL (odds ratio 3.02; 95% CI, 1.63-5.58; < .001) accounting to confounders. Longitudinal arm: the VFx incidence was higher in group B than in group A (19.3% vs 3.6%; = .05). In group B, all incident VFx occurred in patients without low BMD. The F-1mgDST cutoff for predicting an incident VFx was 1.2 µg/dL, although statistical significance was not reached after adjustment for confounders ( = .061).
In NFAI patients, F-1mgDST levels greater than or equal to 1.2 µg/L (33 nmol/L) are associated with prevalent VFx and may identify patients at risk of incident VFx.
无功能肾上腺意外瘤（NFAI）患者发生椎体骨折（VFx）的风险尚不清楚。
本研究旨在评估NFAI患者VFx的患病率和发病率，并确定一种激素标志物以识别有风险的患者。
对门诊患者进行了一项回顾性、横断面和纵向研究。共评估了306例NFAI患者（横断面组）和213例对照者的VFx患病率；对85例NFAI患者（纵向组，随访30.3±17.5个月）评估VFx发病率。主要观察指标包括1毫克地塞米松试验（F-1mgDST）后的血清皮质醇、腰椎（LS）和股骨颈（FN）骨密度（BMD）以及通过脊柱X线片检查VFx的存在情况。
横断面组：VFx患病率与F-1mgDST相关，临界值为1.2μg/dL（33nmol/L）（曲线下面积0.620±0.39；P = 0.002）。与对照组和F-1mgDST低于1.2μg/dL的NFAI患者（A组）相比，F-1mgDST大于或等于1.2μg/dL的NFAI患者（B组）的VFx患病率更高（分别为10.8%、12.6%和29.5%；所有比较P<0.001），校正混杂因素后，这与F-1mgDST大于或等于1.2μg/dL相关（比值比3.02；95%CI，1.63 - 5.58；P<0.001）。纵向组：B组的VFx发病率高于A组（19.3%对3.6%；P = 0.05）。在B组中，所有新发VFx均发生在骨密度未降低的患者中。预测新发VFx的F-1mgDST临界值为1.2μg/dL，尽管校正混杂因素后未达到统计学显著性（P = 0.061）。
在NFAI患者中，F-1mgDST水平大于或等于1.2μg/L（33nmol/L）与VFx患病率相关，可能识别有新发VFx风险的患者。
