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Adrenalectomy Reduces the Risk of Vertebral Fractures in Patients With Mild Autonomous Cortisol Secretion
Valentina Morelli1, Vittoria Favero2,3, Sofia Frigerio4
1Endocrinology Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, 20149 Milan, Italy.
The Journal of Clinical Endocrinology and Metabolism
|April 11, 2025
Summary
Adrenalectomy significantly reduces vertebral fracture risk in patients with mild autonomous cortisol secretion (MACS). Recovery from MACS through surgery improves bone health outcomes compared to conservative management.
Area of Science:
- Endocrinology
- Bone Metabolism
- Surgical Intervention
Background:
- Mild autonomous cortisol secretion (MACS) is linked to a higher risk of vertebral fractures (VFx).
- The effect of MACS recovery on bone health is not well understood.
Purpose of the Study:
- To investigate the impact of adrenalectomy versus conservative treatment on bone health in patients with MACS.
- To assess changes in bone mineral density (BMD) and fracture incidence.
Main Methods:
- Two studies were conducted: a retrospective intervention study and a prospective randomized study.
- Patients with MACS (diagnosed via adrenal incidentalomas and dexamethasone suppression test) were assessed for BMD, calcium-phosphorus metabolism, and VFx.
Main Results:
- In Study 1, surgery group had fewer VFx (9.7%) than the conservative group (50%).
- In Study 2, the adrenalectomy group showed a significantly lower incidence of VFx (4.8%) compared to the conservative group (25%) after 24 months.
- BMD remained stable in both groups, but calcium and phosphorus levels increased post-adrenalectomy.
Conclusions:
- Adrenalectomy is an effective treatment for reducing vertebral fracture risk in patients with adrenal incidentalomas and MACS.
- Surgical intervention for MACS demonstrates a positive impact on bone health by mitigating fracture risk.
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