ECE2020 ePoster Presentations Bone and Calcium (65 abstracts)
Cortisol secreting adrenal adenoma. A clinically silent cause of osteoporosis
Ifigenia Kostoglou-Athanassiou 1 , Lambros ATHANASSIOU 2 , Alexandros Ginis 3 , Erasmia Manta 4 , Pavlos Tsakiridis 5 , Andreas Giannakopoulos 4 , Alexandros Pastroudis 4 & Panagiotis Athanassiou 5
1Department of Endocrinology, Asclepeion Hospital, Voula, Athens, Greece; 2Department of Physiology, Medical School, University of Athens, Athens, Greece; 3Endocrinologist, Athens, Greece; 46th Department of Orthopedics, Asclepeion Hospital, Voula, Athens, Greece; 5Department of Rheumatology, St. Paul’s Hospital, Thessaloniki, Greece
Adrenal adenomas are nowadays frequently diagnosed in the context of abdominal imaging. Osteoporosis may be a presenting manifestation of a cortisol producing adrenal adenoma. The aim was to present two cases of patients diagnosed and treated for osteoporosis who later in the course of the disease were diagnosed with a cortisol producing adrenal adenoma. Two patients, female aged 53 and 56 years, respectively, presented with osteoporosis. T score was −2.8 and −3.0 in the left hip, respectively. Bisphosphonates were administered. During follow-up the first patient developed gastritis and vague abdominal pain. An abdominal CT scan was performed which revealed an adrenal adenoma in the left adrenal gland measuring 1.8×2.6 cm. An extensive laboratory investigation revealed increased 24 h urinary cortisol levels, marginally decreased morning ACTH levels and normal morning cortisol levels. Cortisol levels were not suppressed after an overnight dexamethasone test. The diagnosis of a cortisol secreting adrenal adenoma was made. The second patient developed anemia during follow-up and an upper abdominal MRI was performed. The MRI revealed an adrenal adenoma measuring 1.2×1.8 cm. Laboratory evaluation revealed decreased morning ACTH levels, marginally increased urinary cortisol levels while morning cortisol levels were not suppressed after a low dose dexamethasone suppression test. Both patients did not have evidence of clinical Cushing’s syndrome. Both patients were treated surgically for the adrenal adenoma. A year later laboratory evaluation revealed normal cortisol, urinary cortisol and morning ACTH levels. Osteoporosis improved after the excision of the adrenal adenoma. Bisphosphonates were discontinued. In conclusion, cortisol secreting adrenal adenomas may be a silent cause of osteoporosis. Osteoporosis resolves after surgical treatment of the adrenal adenoma.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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