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Adrenocortical incidentalomas and bone: from molecular insights to clinical perspectives

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A Correction to this article was published on 10 September 2018

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Abstract

Adrenal incidentalomas constitute a common clinical problem with an overall prevalence of around 2–3%, but are more common with advancing age being present in 10% of those aged 70 years. The majority of these lesions are benign adrenocortical adenomas (80%), characterized in 10–40% of the cases by autonomous cortisol hypersecretion, and in 1–10% by aldosterone hypersecretion. Several observational studies have shown that autonomous cortisol and aldosterone hypersecretion are more prevalent than expected in patients with osteopenia and osteoporosis: these patients have accelerated bone loss and an increased incidence of vertebral fractures. In contrast to glucocorticoid action, the effects of aldosterone on bone are less well understood. Recent data, demonstrating a concomitant co-secretion of glucocorticoid metabolites in patients with primary aldosteronism, could explain some of the metabolic abnormalities seen in patients with aldosterone hypersecretion. In clinical practice, patients with unexplained osteoporosis, particularly when associated with other features such as impaired glucose tolerance or hypertension, should be investigated for the possible presence of autonomous cortisol or aldosterone secretion due to an adrenal adenoma. Randomized intervention studies are needed, however, to investigate the optimum interventions for osteoporosis and other co-morbidities in these patients.

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Change history

  • 10 September 2018

    The original version of this article unfortunately contained a mistake in Figure 1. There is a typo in the word “osteoclastogenesis” and the word “activity” is missing in the same entity. It should be “osteoclastogenesis” instead of “osteoclestogenesis”.

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Authors and Affiliations

  1. Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Wuerzburg, Wuerzburg, Germany

    Barbara Altieri, Martin Fassnacht & Cristina L. Ronchi

  2. Division of Endocrinology and Metabolic Diseases, Institute of Medical Pathology, Catholic University of the Sacred Heart, Rome, Italy

    Barbara Altieri, Silvia Della Casa & Alfredo Pontecorvi

  3. Department of Clinical Medicine and Surgery, University “Federico II”, Naples, Italy

    Giovanna Muscogiuri

  4. Division of Endocrinology and Diabetes, “Aghia Sophia” Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece

    Stavroula A. Paschou

  5. Department of Endocrinology and Diabetes, Hellenic Red Cross Hospital, Athens, Greece

    Andromachi Vryonidou

  6. Institute of Metabolism and System Research, University of Birmingham, Birmingham, UK

    Cristina L. Ronchi

  7. Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK

    John Newell-Price

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  1. Barbara Altieri
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The original version of this article was revised: The typo in Figure 1 is corrected.

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Altieri, B., Muscogiuri, G., Paschou, S.A. et al. Adrenocortical incidentalomas and bone: from molecular insights to clinical perspectives. Endocrine 62, 506–516 (2018). https://doi.org/10.1007/s12020-018-1696-z

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