Romanian Journal of Medical Practice (Dec 2019)
OSTEOPOROSIS AND ADRENAL INCIDENTALOMA: TO BE OR NOT TO BE?
Abstract
Introduction. Adrenal incidentaloma is a more frequent diagnosis during the last decades since the relative access to abdominal ultrasound, computed tomography or magnetic resonance imagery is higher. Aim. Our aim is to focus on the relationship between bone status (BS) in patients diagnosed and confirmed with adrenal incidentaloma. Method. This is a mini-review of the literature. Most of the included papers were published during the last 5 years. The main research tool is PubMed database. General data. BS is affected in adrenal incidentaloma mainly through persistent autonomous cortisol production which is called (even lately the term is not encouraged) “subclinical Cushing’s syndrome” with a prevalence of 0.2 up to 2% in unselected series of adult people. TBS (Trabecular Bone Score) in both men and women is negatively correlated with plasma cortisol after 1 mg dexamethasone suppression test. There is 2.2% decrease of TBS if subclinical Cushing’s syndrome is confirmed opposite to clear non-functioning pattern of the adrenal incidenaloma. Bone mineral density based on DXA at central sites (lumbar spine and femoral neck) was similar between the subject with unilateral and bilateral incidentaloma. The presence of subliclinical hypercortisolism is positively correlated with a higher risk of osteoporosis and fragility fractures Recently the term of “high risk” patients with adrenal incidentaloma has been introduced in order to describe the subgroup with autonomous cortisol secretion that has an increased risk of cardiovascular morbidities, infections and fractures (even independently of DXA - bone mineral density. Conclusion. The main contributor to BS, as well as to the cardiometabolic damage, remains the autonomous cortisol secretion in adrenal incidentaloma with a potential improvement after adrenalectomy and without a specific anti-osteoporotic medication in this particular situation.
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