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Evaluation of bone health in patients with adrenal tumors

Athimulam, Shobana; Bancos, Irina

Current Opinion in Endocrinology, Diabetes and Obesity: June 2019 - Volume 26 - Issue 3 - p 125–132
doi: 10.1097/MED.0000000000000478

Purpose of review Adrenal tumors occur in 5% of population with higher prevalence in elderly. Patients with adrenal tumors present with overt hormonal excess in up to 15% of cases, and mild autonomous cortisol secretion in 30–40% of cases. Overt Cushing syndrome, mild autonomous cortisol secretion, pheochromocytoma, and primary aldosteronism have been associated with higher cardiovascular morbidity and mortality. Increasing experimental and clinical evidence also suggests that adrenal hormone excess is detrimental to bone health. This review aims to discuss the effect of cortisol, aldosterone, and catecholamine excess on bone metabolism, secondary osteoporosis, and fragility fractures.

Recent findings Several studies have reported that patients with hormonally active adrenal tumors demonstrate increased prevalence of fragility fractures incongruous to bone density scan findings. The utility of dual absorptiometry X-ray (DXA) in diagnosing secondary osteoporosis is unclear in patients with cortisol, aldosterone, and catecholamine excess. Trabecular bone score and bone turn over markers could serve as potential diagnostic tools in assessment of severity of bone disease in patients with hormonally active adrenal tumors.

Summary Adrenalectomy is the mainstay of therapy in patients with overt hormone production. Appropriate case detection strategies to identify patients at risk of fragility fractures are needed in patients not treated with adrenalectomy, such as bilateral primary aldosteronism and mild autonomous cortisol secretion.

Division of Endocrinology, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA

Correspondence to Irina Bancos, MD, Division of Endocrinology, Metabolism and Nutrition, Mayo Clinic, 200 First street SW, Rochester, MN 55905, USA. Tel: +1 507 776 1387; e-mail:

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