Osteoporosis International

, Volume 29, Issue 10, pp 2299–2307 | Cite as

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

  • B.-J. Kim
  • M.K. Kwak
  • S.H. Ahn
  • J.S. Kim
  • S.H. LeeEmail author
  • J.-M. KohEmail author
Original Article



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.


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).


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).


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 < 0.001), but not men. This inverse association of cortisol/DHEA-S ratio in women remained statistically significant after adjusting for the serum cortisol level after 1 mg DST (β = − 0.221, P = 0.008). Compared with women with NFAI, women with SH had 2.2% lower TBS (P = 0.040). Deteriorated bone microstructure (TBS < 1.230) was associated with the serum cortisol level after 1 mg DST (odds ratio [OR], 2.18; 95% confidence interval [CI], 1.04–4.53) and cortisol/DHEA-S ratio (OR, 2.05; 95% CI, 1.03–4.08).


Subtle cortisol excess in both genders and reduced DHEA-S, especially in women, may contribute to impaired bone quality in Asian patients with SH.


Bone mineral density Cortisol Dehydroepiandrosterone-sulfate Subclinical hypercortisolism Trabecular bone score 


Funding information

This study was supported by grants from the Asan Institute for Life Sciences, Seoul, Republic of Korea (Project No. 2014-1215) and from the Korea Health Technology R&D Project, Ministry of Health and Welfare, Republic of Korea (Project HI15C0377).

Compliance with ethical standards

Conflicts of interest


Supplementary material

198_2018_4608_MOESM1_ESM.docx (117 kb)
ESM 1 (DOCX 117 kb)


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2018

Authors and Affiliations

  1. 1.Division of Endocrinology and Metabolism, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulSouth Korea
  2. 2.Department of EndocrinologyInha University School of MedicineIncheonSouth Korea
  3. 3.Department of Nuclear Medicine, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulSouth Korea

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