A longitudinal study of dual-energy X-ray absorptiometry status in menopausal women with adrenal tumors.

INTRODUCTION

Adrenal tumors involve multidisciplinary challenges, including bone health impairment due to mild or fully manifested cortisol overproduction by the adrenal cortex.

AIM: We aimed to assess dual-energy X-ray absorptiometry (DXA)-based category switch in non-surgery candidates who were initially diagnosed with non-functional adrenal tumors (NFATs) at computed tomography (CT).

PATIENTS, MATERIALS AND

METHODS

This was real-life setting associated with a longitudinal analysis in menopausal individuals (age range: 50 to 80 years) diagnosed with NFATs who had a central DXA scan at baseline and during monitorization.

EXCLUSION CRITERIA: malignancies, functional adrenal tumors.

RESULTS

The initial cohort (n=33) included: 21.21% of the patients had osteoporosis (group A), 60.61% had osteopenia (group B) and 18.18% had normal DXA (group C), with similar age and menopause duration, but higher body mass index (BMI) in group C vs. group A (35.33±8.61 vs. 26.82±4.00 kg∕m²; p=0.039). Hormonal and CT-based features were similar among the groups. Group C had higher osteocalcin vs. group B (30.93±14.07 vs. 18.88±8.42; p=0.051). Baseline morning (plasma) cortisol negatively correlated with DXA-bone mineral density (BMD) at femoral neck (r=-0.539, p=0.017). Median follow-up was similar among the groups (50 months, Q1-Q3 quartiles: 24 to 71 months). 66.67% of patients from group C experienced a DXA category switch vs. group B (20.00%; p=0.051). Decrease DXA category switch was more prevalent in group C vs. group A (p=0.021), respectively, group C vs. group B (p=0.013).

CONCLUSIONS

Sharpest DXA-BMD decline was between 48 and 72 months. The cumulative probabilities of decrease DXA category switch-free survival were higher in osteopenia vs. normal (p-value log-rank: 0.026), indicating that patients with normal results of DXA-BMD were more likely to decrease category in comparison to the subjects initially confirmed with osteopenia. To our best knowledge, only a limited number of studies longitudinally assessed bone status in NFATs so far.