Adrenalectomy significantly reduced the risk for vertebral fractures compared with conservative care in adults with mild autonomous cortisol secretion (MACS), according to data from a recent study.
Previous research suggested that MACS occurs in approximately half of the patients with adrenal incidentalomas and may promote cardiometabolic conditions, but recovery from MACS may reduce this risk, wrote Valentina Morelli, MD, of IRCCS Istituto Auxologico Italiano, Milan, Italy, and colleagues.
“Among the other possible complications correlated with MACS is skeletal fragility, and in particular, some studies have shown that patients with MACS have an increased prevalence and incidence of vertebral fractures compared to patients with nonfunctioning tumors,” said co-author Vittoria Favero, MD, of the University of Milan, Milan, Italy, in an interview. However, intervention studies on the possible effect of the recovery from MACS on bone fragility are lacking, she said.
The European Society of Endocrinology clinical practice guidelines on the management of adrenal incidentalomas developed in collaboration with the European Network for the Study of Adrenal Tumors (ESE-ENSAT guidelines of 2023) regarded the link between MACS and osteoporosis as not well established. The current study sought to address the effect of treating MACS on bone health, specifically the risk for vertebral fractures, Favero told Medscape Medical News.
The researchers performed separate analyses of two cohorts of patients with MACS, one through a retrospective study and the other via a prospective study. Their findings were published in The Journal of Clinical Endocrinology & Metabolism.
In the retrospective study, 53 adult outpatients with MACS were followed for approximately 35 months after undergoing adrenalectomy or conservative care to evaluate the incidence of vertebral fractures.
In the prospective study, 51 adult outpatients with MACS were randomized to adrenalectomy or conservative care and followed for 24 months to evaluate the effect of adrenalectomy on outcomes potentially associated with hypercortisolism, including vertebral fractures, body weight, blood pressure, bone mineral density (BMD), and glucometabolic control.
In the retrospective study, the percentage of women was 74.2% in the surgical group and 45.5% in the conservative care group; the average ages were 63 and 64 years, respectively.
For the prospective study, women accounted for 67% of the surgical group and 78% of the conservative care group, with average ages of 63