Endocrine Abstracts

Introduction: Some studies have already described an association between mild autonomous cortisol secretion and poorer bone quality and increased risk of fracture. However, no consensus exists on this topic and currently there are no guidelines recommending bone status evaluation in patients suffering from this condition.

Aims: To evaluate bone mineral density in patients diagnosed with autonomous cortisol secretion (ACS) and possible autonomous cortisol secretion (PACS).

Methods: Cross-sectional study with adult patients with ACS or PACS currently under follow-up at our center. The 1mg overnight dexamethasone test was used to define both entities: PACS if the post-dexamethasone serum cortisol level was 1.9–5.0μg/dL and ACS if it was >5.0μg/dL. Bone mineral density was evaluated by dual-energy x-ray absorptiometry directed at the lumbar spine and femoral neck.

Results: A total of 39 patients were included, 21 (53.8%) of them were women (all post-menopausal). Their median age was 67.0(59.0-73.0) years and their median BMI was 26.6(23.3-29.8) Kg/m². 26 (66.7%) were diagnosed with PACS and 13 (33.3%) with ACS. Fourteen (35.9%) patients had type 2 Diabetes mellitus, 16 (41.0%) had dyslipidemia and 8 (20.5%) had obesity. The overall prevalence of osteopenia was 46.2% (n=18) and of osteoporosis was 20.5% (n=8). When analyzing the prevalence of osteopenia and osteoporosis by subgroups, no significant differences were found between both sexes, in elderly patients, smokers, patients with diabetes or patients with obesity (p>0.05). Patients with bilateral adenomas were not more frequently diagnosed with osteoporosis (P=0.664) or osteopenia (P=0.708). Similarly, no differences were found in patients that had elevated urinary cortisol (P=0.515 and P=0.124) or elevated late-night salivary cortisol (P=0.137 and P=0.813). Patients who had more than one adrenal adenoma were also not more frequently diagnosed with osteoporosis (P=0.351) or osteopenia (P=0.757), as well as patients with big adenomas –>4cm in diameter – (P=0.652 and P=0.520). Patients diagnosed with ACS were not more frequently diagnosed with osteopenia than patients diagnosed with PACS (30,8% vs 53,8%, P=0.173) but were more frequently diagnosed with osteoporosis (45,5% vs 12,0%, P=0,026).

Conclusions: Both osteopenia and osteoporosis were prevalent in patients with PACS or ACS. Comparing to the overall prevalence of osteoporosis in the Portuguese population (10.2%), this numbers were alarmingly high. Therefore, it seems legit to screen for bone disease in this population, in order to provide directed treatment and eventually consider adrenalectomy. It would also be interesting to screen for asymptomatic vertebral fractures and to analyze bone turnover markers in this population.