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Bone Loss Rate in Adrenal Incidentalomas: A Longitudinal Study

Clinical and Research Unit of Endocrinology (I.C., M.T., V.T., A.S.), Unit of Internal Medicine (V.C.), and Department of Radiology (G.G., M.C.), Scientific Institute Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Foggia, Italy; and Unit of Endocrinology, San Giuseppe-Fatebenefratelli A.Fa.R. Hospital (I.C.), Milan, Italy

Address all correspondence and requests for reprints to: Alfredo Scillitani, M.D., Clinical and Research Unit of Endocrinology, Scientific Institute Casa Sollievo della Sofferenza, Viale Cappuccini, 71013 San Giovanni Rotondo, Foggia, Italy. E-mail: endocrinologia{at}operapadrepio.it

Abstract

Although by definition patients with adrenal incidentalomas (AI) do not have evident clinical syndromes, they may frequently suffer from subclinical hypercortisolism (SH). This is of some importance because of evidence that SH may lead to clinical complications, including bone loss. Thus, the understanding of bone involvement due to SH may be extremely important in the management of AI. Unfortunately, the available data on bone mineral density (BMD) in AI patients come from cross-sectional studies, which, to further complicate our understanding, are also conflicting, probably due to a different selection of patients and/or the variability in cortisol secretion (CS) often described in AI. To gain further insight about this topic, we performed a longitudinal study evaluating the rate of spinal and femoral bone loss levels in 24 females with AI.

AI subjects were subdivided in two groups on the basis of the median of urinary cortisol secretion (UFC): group I (n = 12; UFC, <140.4 nmol/24 h) and group II (n = 12; UFC, >140.4 nmol/24 h). Spinal BMD was measured by both single energy quantitative computed tomography (L1–L4) and dual energy x-ray absorptiometry (DXA; L2–L4), and femoral BMD was determined by DXA. Bone loss rate was expressed as the change in z-score per yr.

The spinal bone loss rate was higher (P < 0.005) in group II than in group I when measured by both quantitative computed tomography (-0.19 ± 0.14 vs. 0.00 ± 0.15) and DXA (-0.19 ± 0.17 vs. 0.00 ± 0.11). Moreover, CS and spinal bone loss rate were significantly correlated when patients were considered together.

In conclusion, our data show that 1) AI patients with higher CS have increased lumbar trabecular bone loss rate than those with lower CS; and 2) the degree of spinal bone loss rate is related to the degree of CS. Thus, lumbar spine (LS) BMD has to be evaluated for well balanced decision-making on the treatment of choice for AI female patients.

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