Endocrine Abstracts

Introduction: Menopause correlates endocrine dysfunctions; whether an adrenal incidentaloma represents one of these it is difficult to establish since an age-dependent pattern of incidence has been described. Bone assays are necessary according to years since last menstruation but also if persistent hypercortisolemia is confirmed.

Aim: This is a series of cases incidentally found with an adrenal tumor (AT) and osteopenia while evaluation of their menopausal status.

Results: Sixty six year female accuses intermittent hot flushes and recurrent urinary infections. The menopause’s age is 49. She associates lupus erythematosus, diabetes mellitus, an episode of stroke, and high blood pressure. A right AT was accidently discovered at ultrasound. CT scan confirmed a mass of 1.6/1.9 cm. The endocrine assay revealed non-secretor pattern: normal aldosteron/rennin ratio, suppression of plasma morning cortisol (of 1.8 μUI/ml) after 2 days×2 mg Dexametasone (DXM) with low-normal morning ACTH of 15 pg/ml (N:3–66 pg/ml), plasma metanephrines and normetaneprines within normal ranges (of 29.2 pg/ml, N:10–90 pg/ml, respective of 51.4 pg/ml, N:15–180 pg/ml). Bone profile pointed low 25-hydroxyvitamin D=8.52 ng/ml (N:30–100 ng/ml), and lowest DXA BMD at femoral neck=0.879 g/cm², T-score=−1.1 S.D., Z-score=−0.1 S.D.

Eighty three year female is diagnosed since menopause (at age of 50) with calcified myomas. An ultrasound (and later CT scan) revealed a left AT of 3.7/2.5/3.4 cm. She presented normal medullo-adrenal function, as well as aldosteron/rennin ratio. However, a subclinical hypercotisolemia was confirmed and persisted for more than a decade (a value of plasma cortisol of 3 μg/dl after 2 days×2 mg DXM, ACTH of 3.15 pg/ml). Adrenalectomy was refused. Bone profile was also investigated since the diagnosis of AT: osteopenia was stationary during follow-up (lumbar BMD of 0.789 g/cm², T-score=−1.8 S.D., Z-score=−0.1 S.D.) in association with vitamin D deficiency.

Conclusion: Adrenal tumors-related bone anomalies are more pronounced in menopause correlated with physiological lack of estrogens. Mild persistent cortisol levels may play a role in low BMD; however the exact component is difficult to establish in this particular population.