The association of cortisol and adrenal androgen with trabecular bone score in patients with adrenal incidentaloma with and without autonomous cortisol secretion

• Published in: Osteoporosis international 2018-10, Vol.29 (10), p.2299-2307
• Main Authors: Kim, B.-J., Kwak, M.K., Ahn, S.H., Kim, J.S., Lee, S.H., Koh, J.-M.
• Format: Article
• Language: English
• Subjects: Absorptiometry, Photon - methods; Adrenal Gland Neoplasms - blood; Adrenal Gland Neoplasms - complications; Adrenal Gland Neoplasms - epidemiology; Adrenal Gland Neoplasms - physiopathology; Adrenal glands; Adrenocorticotropic hormone; Aged; Androgens; Bone Density - physiology; Cancellous bone; Cancellous Bone - physiopathology; Cortisol; Cultural differences; Cushing syndrome; Cushing Syndrome - blood; Cushing Syndrome - epidemiology; Cushing Syndrome - etiology; Cushing Syndrome - physiopathology; Dehydroepiandrosterone; Dehydroepiandrosterone Sulfate - blood; Dexamethasone; Endocrinology; Female; Hormones; Humans; Hydrocortisone - blood; Incidental Findings; Lumbar Vertebrae - physiopathology; Male; Medicine; Medicine & Public Health; Middle Aged; Nervous system diseases; Original Article; Orthopedics; Osteoporosis; Pituitary; Republic of Korea - epidemiology; Rheumatology; Secretion; Sex Factors; Statistical analysis; Sulfates
• ISSN: 0937-941X; 1433-2965
• DOI: 10.1007/s00198-018-4608-4

Summary Despite ethnic differences in cortisol sensitivity, only one study in Caucasians has assessed trabecular bone score (TBS) in patients with subclinical hypercortisolism (SH). We showed that both subtle cortisol excess and reduced adrenal androgen may contribute to impaired bone quality in Asian women with SH. Introduction One study in Caucasians has assessed trabecular bone score (TBS), an index of bone microstructure, in adrenal incidentaloma (AI) patients with subclinical hypercortisolism (SH). There are ethnic differences in cortisol sensitivities between Caucasian and Asian populations. We investigated the associations of cortisol and the adrenal androgen dehydroepiandrosterone-sulfate (DHEA-S) with TBS in AI patients with SH, adrenal Cushing’s syndrome (CS), and nonfunctional AI (NFAI). Methods We measured TBS, cortisol levels after the overnight 1 mg dexamethasone suppression test (1 mg DST), and cortisol/DHEA-S in 61 patients with SH (30 men; 31 women), 19 with adrenal CS (4 men; 15 women), and 355 with NFAI (213 men; 142 women). Results After adjusting for confounders, the serum cortisol level after 1 mg DST was inversely correlated with TBS in men ( β  = −0.133, P  = 0.045) and women ( β  = − 0.140, P  = 0.048). Higher cortisol/DHEA-S ratio was associated with lower TBS in women ( β  = − 0.252, P