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Endocrine. 2018 Dec;62(3):506-516. doi: 10.1007/s12020-018-1696-z. Epub 2018 Aug 2.

Adrenocortical incidentalomas and bone: from molecular insights to clinical perspectives.

Author information

1
Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Wuerzburg, Wuerzburg, Germany. altieri.barbara@gmail.com.
2
Division of Endocrinology and Metabolic Diseases, Institute of Medical Pathology, Catholic University of the Sacred Heart, Rome, Italy. altieri.barbara@gmail.com.
3
Department of Clinical Medicine and Surgery, University "Federico II", Naples, Italy.
4
Division of Endocrinology and Diabetes, "Aghia Sophia" Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
5
Department of Endocrinology and Diabetes, Hellenic Red Cross Hospital, Athens, Greece.
6
Division of Endocrinology and Metabolic Diseases, Institute of Medical Pathology, Catholic University of the Sacred Heart, Rome, Italy.
7
Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Wuerzburg, Wuerzburg, Germany.
8
Institute of Metabolism and System Research, University of Birmingham, Birmingham, UK.
9
Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK.

Abstract

Adrenal incidentalomas constitute a common clinical problem with an overall prevalence of around 2-3%, but are more common with advancing age being present in 10% of those aged 70 years. The majority of these lesions are benign adrenocortical adenomas (80%), characterized in 10-40% of the cases by autonomous cortisol hypersecretion, and in 1-10% by aldosterone hypersecretion. Several observational studies have shown that autonomous cortisol and aldosterone hypersecretion are more prevalent than expected in patients with osteopenia and osteoporosis: these patients have accelerated bone loss and an increased incidence of vertebral fractures. In contrast to glucocorticoid action, the effects of aldosterone on bone are less well understood. Recent data, demonstrating a concomitant co-secretion of glucocorticoid metabolites in patients with primary aldosteronism, could explain some of the metabolic abnormalities seen in patients with aldosterone hypersecretion. In clinical practice, patients with unexplained osteoporosis, particularly when associated with other features such as impaired glucose tolerance or hypertension, should be investigated for the possible presence of autonomous cortisol or aldosterone secretion due to an adrenal adenoma. Randomized intervention studies are needed, however, to investigate the optimum interventions for osteoporosis and other co-morbidities in these patients.

KEYWORDS:

Adrenal; Autonomous cortisol hypersecretion; Bone; Incidentaloma; Osteoporosis; Primary aldosteronism

PMID:
30073456
DOI:
10.1007/s12020-018-1696-z

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