Prediction of vertebral fractures in patients with monolateral adrenal incidentalomas

Valentina Morelli, Cristina Eller-Vainicher, Serena Palmieri, Elisa Cairoli, Antonio Stefano Salcuni, Alfredo Scillitani, Vincenzo Carnevale, Sabrina Luigia Corbetta, Maura Arosio, Silvia Della Casa, G. Muscogiuri, Anna Maria Spada, Iacopo Chiodini

Research output: Contribution to journalArticle

Abstract

Context: Subtle hypercortisolism is associated with an increased risk of vertebral fracture (VFx). Objective: The objective was to determine the best parameters of cortisol secretion for detecting the VFx risk in patients with adrenal incidentalomas (AI). Design: This was a retrospective (cross-sectional arm) and prospective (longitudinal arm) design. In the cross-sectional arm, we assessed the accuracy of the cortisol secretion indexes in identifying the patients with VFx (prevalent VFx). In the longitudinal arm, we tested the cortisol secretion parameters, which were able to identify the prevalent VFx, for the prediction of the occurrence of a new VFx (incident VFx) in AI patients followed-up for at least 2 years. Setting: Four referral Italian endocrinology units participated in this study. Patients: A total of 444 and 126 AI patients without symptoms of hypercortisolism enrolled in the cross-sectional arm and longitudinal arm, respectively. Main Outcome Measures: Serum cortisol after a 1-mg dexamethasone suppression test (1 mg DST), urinary free cortisol, ACTH, bone mineral density at lumbar spine and femoral neck (by dual-energy X-ray absorptiometry), and the VFx presence (by X-ray). Results: The cortisol levels after 1 mg DST that were greater than 2.0-g/dl (55 nmol/liter) were the best criteria for detecting patients with both prevalent (73.6% sensitivity, 70.5% specificity) and incident VFx (80% sensitivity, 68.8% specificity) and were associated with a 10-fold increased risk of a new VFx (odds ratio,10.27; 95% confidence interval, 3.39-31.12; P

Original languageEnglish
Pages (from-to)2768-2775
Number of pages8
JournalJournal of Clinical Endocrinology and Metabolism
Volume101
Issue number7
DOIs
Publication statusPublished - Jul 1 2016

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Hydrocortisone
Cushing Syndrome
Dexamethasone
Endocrinology
Sensitivity and Specificity
X rays
Femur Neck
Photon Absorptiometry
Bone Density
Adrenocorticotropic Hormone
Minerals
Adrenal incidentaloma
Bone
Spine
Referral and Consultation
Odds Ratio
X-Rays
Outcome Assessment (Health Care)
Confidence Intervals
Serum

ASJC Scopus subject areas

  • Biochemistry
  • Clinical Biochemistry
  • Endocrinology
  • Biochemistry, medical
  • Endocrinology, Diabetes and Metabolism

Cite this

Prediction of vertebral fractures in patients with monolateral adrenal incidentalomas. / Morelli, Valentina; Eller-Vainicher, Cristina; Palmieri, Serena; Cairoli, Elisa; Salcuni, Antonio Stefano; Scillitani, Alfredo; Carnevale, Vincenzo; Corbetta, Sabrina Luigia; Arosio, Maura; Casa, Silvia Della; Muscogiuri, G.; Spada, Anna Maria; Chiodini, Iacopo.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 101, No. 7, 01.07.2016, p. 2768-2775.

Research output: Contribution to journalArticle

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AU - Morelli, Valentina

AU - Eller-Vainicher, Cristina

AU - Palmieri, Serena

AU - Cairoli, Elisa

AU - Salcuni, Antonio Stefano

AU - Scillitani, Alfredo

AU - Carnevale, Vincenzo

AU - Corbetta, Sabrina Luigia

AU - Arosio, Maura

AU - Casa, Silvia Della

AU - Muscogiuri, G.

AU - Spada, Anna Maria

AU - Chiodini, Iacopo

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