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

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Abstract

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 < 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).

Conclusions

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

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Funding

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).

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Author notes

  1. S.H. Lee and J.-M. Koh contributed equally to this work.

Authors and Affiliations

  1. Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, South Korea

    B.-J. Kim, M.K. Kwak, S.H. Lee & J.-M. Koh

  2. Department of Endocrinology, Inha University School of Medicine, Incheon, 22332, South Korea

    S.H. Ahn

  3. Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, South Korea

    J.S. Kim

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Kim, BJ., Kwak, M., Ahn, S. et al. The association of cortisol and adrenal androgen with trabecular bone score in patients with adrenal incidentaloma with and without autonomous cortisol secretion. Osteoporos Int 29, 2299–2307 (2018). https://doi.org/10.1007/s00198-018-4608-4

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  • DOI: https://doi.org/10.1007/s00198-018-4608-4

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