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Bone Involvement in Eugonadal Male Patients with Adrenal Incidentaloma and Subclinical Hypercortisolism

Units of Endocrinology (I.C., M.T., C.B., V.T., A.S.), Radiology (G.G., M.C.), and Internal Medicine (V.C.), Scientific Institute Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo (Foggia), Italy; Unit of Endocrinology (I.C., S.D.L.), San Giuseppe-Fatebenefratelli Hospital, Fatebenefratelli Association for Research, 20123 Milano, Italy; Unit of Endocrinology (L.T., A.C., R.R.), "Federico II" University, 80129 Napoli, Italy; and Department of Clinical Sciences (V.T.), "La Sapienza" University, 00498 Rome, Italy

Address all correspondence and requests for reprints to: Alfredo Scillitani, M.D., Unit of Endocrinology, Scientific Institute Casa Sollievo della Sofferenza, Viale Cappuccini, 71013 San Giovanni Rotondo (Foggia), Italy. E-mail: endocrino{at}operapadrepio.it.

Abstract

Adrenal incidentalomas (AI) are not associated, by definition, with clinically evident syndromes; however, some AI patients may show biochemical indexes of subclinical hypercortisolism (SH). Previous data on female AI patients indicated that SH may lead to bone loss, at least at spine. No data are available on bone involvement in samples of only AI male patients.

We measured bone metabolism and bone mineral density at spine and femur by dual-energy x-ray absorptiometry in 38 consecutive eugonadal male AI patients and 38 healthy matched control subjects. Patients were subdivided according to the presence or absence of SH (group SH+ and group SH-, respectively). Mean Z-score levels of spinal bone mineral density measured by dual-energy x-ray absorptiometry were lower (P < 0.05) in group SH+ (-0.42 ± 1.62) in comparison with group SH- (0.6 ± 1.13) and controls (0.47 ± 1.06). Thus, in order for the most appropriate management to be individually tailored, bone mass evaluation is strongly indicated in AI male patients with SH, irrespective of their gonadal status.

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