Increased Risk of Vertebral Fractures in Patients With Mild Autonomous Cortisol Secretion
© The Author(s) 2023. Published by Oxford University Press on behalf of the Endocrine Society..
CONTEXT: The risk of vertebral fractures (VFx) in patients with adrenal incidentalomas (AI) and mild autonomous cortisol secretion (MACS) is debated.
OBJECTIVE: To evaluate the VFx prevalence and incidence in patients with AI and MACS.
METHODS: This cross-sectional and longitudinal study using retrospective data from 4 Italian endocrinology units included 444 patients (cross-sectional arm) and 126 patients (longitudinal arm, 24.9 ± 5.3 months follow-up) to evaluate prevalent and incident VFx, respectively, in patients with MACS (MACS-yes) and without MACS (MACS-no). The main outcome measures were serum cortisol after a 1-mg dexamethasone test (F-1mgDST), bone mineral density (BMD) by dual-energy x-ray absorptiometry at spine (LS) and femur (FN), and VFx presence by x-ray.
RESULTS: Cross-sectional arm: 214 and 230 patients were MACS-yes and MACS-no, respectively, based on F-1mgDST >1.8 µg/dL (50 nmol/L). Patients with MACS had higher VFx prevalence (62.6%) than those without MACS (22.9%, P < .001); MACS was associated with prevalent VFx (odds ratio, 5.203; 95% CI, 3.361-8.055; P < .001; relative risk [RR] 2.07), regardless of age, body mass index, gender distribution, LS-BMD, and presence of type 2 diabetes mellitus (T2D). Longitudinal arm: 66 and 60 patients were MACS-no and MACS-yes, respectively. Patients without MACS showed higher number of incident VFx (36.4%) than patients without MACS (10.0%, P < .001); MACS was associated with the presence of an incident VFx (RR 4.561; 95% CI, 1.600-13.003; P = .005) regardless of age, LS-BMD, gender distribution, presence of prevalent VFx, and T2D. Results were confirmed in women and men when separately evaluated.
CONCLUSION: Women and men with AI and MACS are at higher risk of VFx.
| Errataetall: |
ErratumIn: J Clin Endocrinol Metab. 2024 Apr 22;:. - PMID 38648187 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:109 |
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| Enthalten in: |
The Journal of clinical endocrinology and metabolism - 109(2024), 2 vom: 18. Jan., Seite e623-e632 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Favero, Vittoria [VerfasserIn] |
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| Links: |
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| Themen: |
Adrenal incidentaloma |
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| Anmerkungen: |
Date Completed 19.01.2024 Date Revised 26.04.2024 published: Print ErratumIn: J Clin Endocrinol Metab. 2024 Apr 22;:. - PMID 38648187 Citation Status MEDLINE |
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| doi: |
10.1210/clinem/dgad560 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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NLM362350752 |
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| 500 | |a Date Revised 26.04.2024 | ||
| 500 | |a published: Print | ||
| 500 | |a ErratumIn: J Clin Endocrinol Metab. 2024 Apr 22;:. - PMID 38648187 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © The Author(s) 2023. Published by Oxford University Press on behalf of the Endocrine Society. | ||
| 520 | |a CONTEXT: The risk of vertebral fractures (VFx) in patients with adrenal incidentalomas (AI) and mild autonomous cortisol secretion (MACS) is debated | ||
| 520 | |a OBJECTIVE: To evaluate the VFx prevalence and incidence in patients with AI and MACS | ||
| 520 | |a METHODS: This cross-sectional and longitudinal study using retrospective data from 4 Italian endocrinology units included 444 patients (cross-sectional arm) and 126 patients (longitudinal arm, 24.9 ± 5.3 months follow-up) to evaluate prevalent and incident VFx, respectively, in patients with MACS (MACS-yes) and without MACS (MACS-no). The main outcome measures were serum cortisol after a 1-mg dexamethasone test (F-1mgDST), bone mineral density (BMD) by dual-energy x-ray absorptiometry at spine (LS) and femur (FN), and VFx presence by x-ray | ||
| 520 | |a RESULTS: Cross-sectional arm: 214 and 230 patients were MACS-yes and MACS-no, respectively, based on F-1mgDST >1.8 µg/dL (50 nmol/L). Patients with MACS had higher VFx prevalence (62.6%) than those without MACS (22.9%, P < .001); MACS was associated with prevalent VFx (odds ratio, 5.203; 95% CI, 3.361-8.055; P < .001; relative risk [RR] 2.07), regardless of age, body mass index, gender distribution, LS-BMD, and presence of type 2 diabetes mellitus (T2D). Longitudinal arm: 66 and 60 patients were MACS-no and MACS-yes, respectively. Patients without MACS showed higher number of incident VFx (36.4%) than patients without MACS (10.0%, P < .001); MACS was associated with the presence of an incident VFx (RR 4.561; 95% CI, 1.600-13.003; P = .005) regardless of age, LS-BMD, gender distribution, presence of prevalent VFx, and T2D. Results were confirmed in women and men when separately evaluated | ||
| 520 | |a CONCLUSION: Women and men with AI and MACS are at higher risk of VFx | ||
| 650 | 4 | |a Journal Article | |
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| 650 | 4 | |a fragility fracture | |
| 650 | 4 | |a mild hypercortisolism | |
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