A Real-World Study in Non-Functional Adrenal Tumours: Refining Central DXA Results

Background: Osteoporosis, a chronic disease with a major epidemiologic impact amid menopause might be aggravated by co-ailments such as adrenal tumours, with an increasing incidence due to a larger access to imaging evaluation. The objective was to evaluate bone profile in relationship with adrenal profile in non-functioning adrenal tumours (NFATs), based on menopausal DXA categories (osteoporosis, osteopenia and normal). Methods: A retrospective real-life study was conducted amid a cross-sectional analysis in anti-osteoporotic drugs naïve subjects. Adrenal profile included baseline morning plasma cortisol (base-cortisol), second-day cortisol (DST-cortisol) after 1 mg dexamethasone testing, ACTH, and largest tumour diameter at CT (D-CT). Results: Ninety-five patients (mean age 61.59 ± 7.83 years) had 24.21% osteoporosis, 47.37% osteopenia, and 28.42%-normal DXA. Base-cortisol, DST-cortisol, ACTH and D-CT were similar between the groups. Total serum calcium was lower in osteoporosis versus osteopenia, versus normal DXA (9.26 ± 0.52 versus 9.61 ± 0.41 mg/dL, p = 0.005, respectively, 9.79 ± 0.47 mg/dL, p < 0.001). Osteocalcin, respectively, CrossLaps were elevated in osteoporosis versus osteopenia. MACS prevalence was 27.37% (no between-group difference). Osteoporosis group: CrossLaps correlated with DST-cortisol (r = -0.550, p = 0.019). Multiple linear regression model to predict lumbar BMD explained 47.1% of the variance in lumbar BMD (R² = 0.471). ACTH was an independent variable for lumbar BMD (p = 0.007). BMI represented the main influential contributor to this model having the highest β of 0.490, and it also explained 49.1% (R² = 0.491) of total hip BMD variation. Conclusions: This study emphasises a heterogeneous connection between adrenal profile in NFATs and clinical evaluation of the bone status. More comprehensive prospective studies are mandatory to assess this multifactorial bone-adrenal interplay in order to improve the overall management.