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Eugonadal male patients with adrenal incidentalomas and subclinical hypercortisolism have increased rate of vertebral fractures
Author(s) -
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,
BeckPeccoz Paolo,
Scillitani Alfredo
Publication year - 2009
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/j.1365-2265.2008.03310.x
Subject(s) - medicine , subclinical infection , bone mineral , femoral neck , endocrinology , dexamethasone suppression test , osteoporosis , gastroenterology , urology , dexamethasone
Summary 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.