Eugonadal male patients with adrenal incidentalomas and subclinical hypercortisolism have increased rate of vertebral fractures

Iacopo Chiodini, Raffaella Viti, Francesca Coletti, Giuseppe Guglielmi, Claudia Battista, Federica Ermetici, Valentina Morelli, Antonio Salcuni, Vincenzo Carnevale, Filomena Urbano, Silvana Muscarella, Bruno Ambrosi, Maura Arosio, Paolo Beck-Peccoz, Alfredo Scillitani

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Abstract

Objective: Subclinical hypercortisolism (SH) is suggested to exert a deleterious effect on bone. This effect and the role of gonadal status in male subjects are not fully elucidated. We evaluated bone mineral density (BMD) and prevalence of vertebral fractures in eugonadal male subjects with adrenal incidentalomas (AI) and without SH. Design: This 12-month observational multicentre study was performed between January and December 2006 on inpatient basis in three referral Italian centres. Patients: Eighty-eight consecutive eugonadal male patients with AI and 90 matched control subjects were studied. Measurements: All subjects underwent the determination of BMD by dual-energy X-ray absorptiometry at lumbar spine (LS) and femoral neck (FN), and spinal radiograph. In AI patients SH was diagnosed in the presence of two of the following: urinary free cortisol > 193.1 nmol/l, cortisol after 1 mg dexamethasone suppression test > 82.8 nmol/l, ACTH levels <2.2 pmol/l. Results: As compared to patients without SH (SH-, n = 66) and controls, patients with SH (SH+, n = 22) had lower BMD at LS (Z-score: SH+, -1.04 ± 1.84; SH-, 0.19 ± 1.34, Controls 0.20 ± 1.28, P = 0.001 and FN (Z-score: SH+, -0.63 ± 1.01; SH-, 0.01 ± 1.01, Controls 0.26 ± 1.06, P = 0.002) and higher prevalence of fractures (SH+, 72.7%; SH-, 21.2%, Controls 20.0%, P = 0.0001). Multivariable analyses showed that SH was associated to BMD at LS (β = -0.378, P = 0.0001) and vertebral fractures (OR = 7.81, 95% CI 1.96-31.17, P = 0.004). Conclusion: In eugonadal male patients with AI, SH is associated with low BMD and high prevalence of vertebral fractures.

Original languageEnglish
Pages (from-to)208-213
Number of pages6
JournalClinical Endocrinology
Volume70
Issue number2
DOIs
Publication statusPublished - Feb 2009

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Cushing Syndrome
Bone Density
Spine
Femur Neck
Adrenal incidentaloma
Hydrocortisone
Photon Absorptiometry
Adrenocorticotropic Hormone
Dexamethasone
Multicenter Studies
Observational Studies

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism

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Eugonadal male patients with adrenal incidentalomas and subclinical hypercortisolism have increased rate of vertebral fractures. / Chiodini, Iacopo; Viti, Raffaella; Coletti, Francesca; Guglielmi, Giuseppe; Battista, Claudia; Ermetici, Federica; Morelli, Valentina; Salcuni, Antonio; Carnevale, Vincenzo; Urbano, Filomena; Muscarella, Silvana; Ambrosi, Bruno; Arosio, Maura; Beck-Peccoz, Paolo; Scillitani, Alfredo.

In: Clinical Endocrinology, Vol. 70, No. 2, 02.2009, p. 208-213.

Research output: Contribution to journalArticle

Chiodini, Iacopo ; Viti, Raffaella ; Coletti, Francesca ; Guglielmi, Giuseppe ; Battista, Claudia ; Ermetici, Federica ; Morelli, Valentina ; Salcuni, Antonio ; Carnevale, Vincenzo ; Urbano, Filomena ; Muscarella, Silvana ; Ambrosi, Bruno ; Arosio, Maura ; Beck-Peccoz, Paolo ; Scillitani, Alfredo. / Eugonadal male patients with adrenal incidentalomas and subclinical hypercortisolism have increased rate of vertebral fractures. In: Clinical Endocrinology. 2009 ; Vol. 70, No. 2. pp. 208-213.
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abstract = "Objective: Subclinical hypercortisolism (SH) is suggested to exert a deleterious effect on bone. This effect and the role of gonadal status in male subjects are not fully elucidated. We evaluated bone mineral density (BMD) and prevalence of vertebral fractures in eugonadal male subjects with adrenal incidentalomas (AI) and without SH. Design: This 12-month observational multicentre study was performed between January and December 2006 on inpatient basis in three referral Italian centres. Patients: Eighty-eight consecutive eugonadal male patients with AI and 90 matched control subjects were studied. Measurements: All subjects underwent the determination of BMD by dual-energy X-ray absorptiometry at lumbar spine (LS) and femoral neck (FN), and spinal radiograph. In AI patients SH was diagnosed in the presence of two of the following: urinary free cortisol > 193.1 nmol/l, cortisol after 1 mg dexamethasone suppression test > 82.8 nmol/l, ACTH levels <2.2 pmol/l. Results: As compared to patients without SH (SH-, n = 66) and controls, patients with SH (SH+, n = 22) had lower BMD at LS (Z-score: SH+, -1.04 ± 1.84; SH-, 0.19 ± 1.34, Controls 0.20 ± 1.28, P = 0.001 and FN (Z-score: SH+, -0.63 ± 1.01; SH-, 0.01 ± 1.01, Controls 0.26 ± 1.06, P = 0.002) and higher prevalence of fractures (SH+, 72.7{\%}; SH-, 21.2{\%}, Controls 20.0{\%}, P = 0.0001). Multivariable analyses showed that SH was associated to BMD at LS (β = -0.378, P = 0.0001) and vertebral fractures (OR = 7.81, 95{\%} CI 1.96-31.17, P = 0.004). Conclusion: In eugonadal male patients with AI, SH is associated with low BMD and high prevalence of vertebral fractures.",
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T1 - Eugonadal male patients with adrenal incidentalomas and subclinical hypercortisolism have increased rate of vertebral fractures

AU - Chiodini, Iacopo

AU - Viti, Raffaella

AU - Coletti, Francesca

AU - Guglielmi, Giuseppe

AU - Battista, Claudia

AU - Ermetici, Federica

AU - Morelli, Valentina

AU - Salcuni, Antonio

AU - Carnevale, Vincenzo

AU - Urbano, Filomena

AU - Muscarella, Silvana

AU - Ambrosi, Bruno

AU - Arosio, Maura

AU - Beck-Peccoz, Paolo

AU - Scillitani, Alfredo

PY - 2009/2

Y1 - 2009/2

N2 - Objective: Subclinical hypercortisolism (SH) is suggested to exert a deleterious effect on bone. This effect and the role of gonadal status in male subjects are not fully elucidated. We evaluated bone mineral density (BMD) and prevalence of vertebral fractures in eugonadal male subjects with adrenal incidentalomas (AI) and without SH. Design: This 12-month observational multicentre study was performed between January and December 2006 on inpatient basis in three referral Italian centres. Patients: Eighty-eight consecutive eugonadal male patients with AI and 90 matched control subjects were studied. Measurements: All subjects underwent the determination of BMD by dual-energy X-ray absorptiometry at lumbar spine (LS) and femoral neck (FN), and spinal radiograph. In AI patients SH was diagnosed in the presence of two of the following: urinary free cortisol > 193.1 nmol/l, cortisol after 1 mg dexamethasone suppression test > 82.8 nmol/l, ACTH levels <2.2 pmol/l. Results: As compared to patients without SH (SH-, n = 66) and controls, patients with SH (SH+, n = 22) had lower BMD at LS (Z-score: SH+, -1.04 ± 1.84; SH-, 0.19 ± 1.34, Controls 0.20 ± 1.28, P = 0.001 and FN (Z-score: SH+, -0.63 ± 1.01; SH-, 0.01 ± 1.01, Controls 0.26 ± 1.06, P = 0.002) and higher prevalence of fractures (SH+, 72.7%; SH-, 21.2%, Controls 20.0%, P = 0.0001). Multivariable analyses showed that SH was associated to BMD at LS (β = -0.378, P = 0.0001) and vertebral fractures (OR = 7.81, 95% CI 1.96-31.17, P = 0.004). Conclusion: In eugonadal male patients with AI, SH is associated with low BMD and high prevalence of vertebral fractures.

AB - Objective: Subclinical hypercortisolism (SH) is suggested to exert a deleterious effect on bone. This effect and the role of gonadal status in male subjects are not fully elucidated. We evaluated bone mineral density (BMD) and prevalence of vertebral fractures in eugonadal male subjects with adrenal incidentalomas (AI) and without SH. Design: This 12-month observational multicentre study was performed between January and December 2006 on inpatient basis in three referral Italian centres. Patients: Eighty-eight consecutive eugonadal male patients with AI and 90 matched control subjects were studied. Measurements: All subjects underwent the determination of BMD by dual-energy X-ray absorptiometry at lumbar spine (LS) and femoral neck (FN), and spinal radiograph. In AI patients SH was diagnosed in the presence of two of the following: urinary free cortisol > 193.1 nmol/l, cortisol after 1 mg dexamethasone suppression test > 82.8 nmol/l, ACTH levels <2.2 pmol/l. Results: As compared to patients without SH (SH-, n = 66) and controls, patients with SH (SH+, n = 22) had lower BMD at LS (Z-score: SH+, -1.04 ± 1.84; SH-, 0.19 ± 1.34, Controls 0.20 ± 1.28, P = 0.001 and FN (Z-score: SH+, -0.63 ± 1.01; SH-, 0.01 ± 1.01, Controls 0.26 ± 1.06, P = 0.002) and higher prevalence of fractures (SH+, 72.7%; SH-, 21.2%, Controls 20.0%, P = 0.0001). Multivariable analyses showed that SH was associated to BMD at LS (β = -0.378, P = 0.0001) and vertebral fractures (OR = 7.81, 95% CI 1.96-31.17, P = 0.004). Conclusion: In eugonadal male patients with AI, SH is associated with low BMD and high prevalence of vertebral fractures.

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