肾上腺腺瘤/偶发瘤伴轻度自主皮质醇分泌(MACS)/亚临床皮质醇增多症(SH)常与代谢综合征相关,糖皮质激素引起的骨质疏松和骨折。在这样的背景下,本系统综述和荟萃分析旨在整理现有证据,并提供MACS/SH在骨折方面对骨骼健康的影响的总结。骨质疏松/骨质减少,微体系结构,和骨周转。PubMed/MEDLINE,Embase,和WebofScience数据库被系统地搜索了报告骨折患病率的观察性研究,骨质疏松症/骨质减少或骨微结构/骨转换标志物(BTMs)的数据。在文献检索之后,纳入16项观察性研究。任何骨折(椎骨和非椎骨)的合并患病率,MACS/SH患者的椎体骨折和骨质疏松/骨质减少为43%[95%置信区间(CI):23%,62%],45%(95%CI:22%,68%)和50%(95%CI:33%,66%),分别。关于元回归,年龄,性别,24小时尿游离皮质醇和硫酸脱氢表雄酮不能预测骨折风险。任何骨折的可能性[优势比(OR)1.61;95%CI:1.18,2.20;p=0.0026],在肾上腺腺瘤和MACS/SH中,椎体骨折(OR2.10;95%CI:1.28,3.45;p=0.0035)和骨质疏松/骨质减少(OR1.46;95%CI:1.15,1.85;p=0.0018)显著高于无功能性肾上腺腺瘤.患有MACS/SH的受试者腰椎的骨矿物质密度(BMD)显着降低[平均差(MD)-0.07gm/cm2;95%CI:-0.11,-0.03;p=0.0004)和股骨颈(MD-0.05gm/cm2;95%CI:-0.08,-0.02;p=0.0045)。有限的数据显示BTMs没有显着差异。在任何骨折的合并患病率中观察到发表偏倚,椎体骨折和股骨颈BMD合并MD。最后,与无功能性肾上腺腺瘤相比,患有肾上腺腺瘤/偶发瘤和MACS/SH的患者发生骨折和骨质疏松/骨质减少的可能性高1.5~2倍,因此应常规筛查骨病.然而,考虑到研究的样本量和发表偏倚的证据,需要更大规模和高质量的研究(CRD42023471045)。
轻度自主皮质醇分泌(MACS),通常也被称为亚临床皮质醇增多症(SH),通常与潜在的肾上腺偶发瘤(AI)有关,腹部成像时偶然发现的肾上腺肿块。尽管缺乏明显的皮质醇过量的迹象,患有MACS/SH的受试者通常具有代谢综合征的特征,骨质疏松症和骨折。本系统综述和荟萃分析显示,任何骨折(椎骨和非椎骨)的合并患病率,MACS/SH的椎骨骨折和骨质疏松/骨质减少占43%,45%和50%,分别。与非功能性肾上腺腺瘤相比,患有肾上腺腺瘤/偶发瘤和MACS/SH的人发生骨折和骨质疏松症/骨质减少的可能性高1.5至2倍。此外,MACS/SH患者腰椎和股骨颈的骨矿物质密度(BMD)明显低于无功能者.因此,必须评估所有MACS/SH受试者的骨骼健康状况。
Adrenal adenomas/incidentalomas with mild autonomous cortisol secretion (MACS)/subclinical hypercortisolism (SH) are often associated with metabolic syndrome, glucocorticoid-induced osteoporosis, and fractures. In this background, the present systematic
review and meta-analysis aimed to collate the available evidence and provide a summary of the effect of MACS/SH on bone health in terms of fractures, osteoporosis/osteopenia, microarchitecture, and bone turnover. PubMed/MEDLINE, Embase, and Web of Science databases were systematically searched for observational studies reporting prevalence of fractures, osteoporosis/osteopenia or data on bone microarchitecture/bone turnover markers (BTMs). Following literature search, 16 observational studies were included. Pooled prevalence of any
fractures (vertebral and non-vertebral), vertebral
fractures, and osteoporosis/osteopenia in MACS/SH were 43% [95% confidence intervals (CI): 23%, 62%], 45% (95% CI: 22%, 68%) and 50% (95% CI: 33%, 66%), respectively. On meta-regression, age, sex, 24-hour urinary free cortisol, and dehydroepiandrosterone-sulfate did not predict fracture risk. The likelihood of any
fractures [odds ratio (OR) 1.61; 95% CI: 1.18, 2.20; P = 0.0026], vertebral
fractures (OR 2.10; 95% CI: 1.28, 3.45; P = 0.0035), and osteoporosis/osteopenia (OR 1.46; 95% CI: 1.15, 1.85; P = 0.0018) was significantly higher in adrenal adenomas and MACS/SH than non-functional adrenal adenomas. Subjects with MACS/SH had significantly lower bone mineral density (BMD) at lumbar spine [mean difference (MD) -0.07 g/cm2; 95% CI: -0.11, -0.03; P = 0.0004) and femoral neck (MD -0.05 g/cm2; 95% CI: -0.08, -0.02; P = 0.0045) than their non-functional counterparts. Limited data showed no significant difference in BTMs. Publication bias was observed in the pooled prevalence of any
fractures, vertebral
fractures and pooled MD of femoral neck BMD. To conclude, people with adrenal adenomas/incidentalomas and MACS/SH are at a 1.5- to 2-fold higher likelihood of fractures and osteoporosis/osteopenia compared to non-functional adrenal adenomas and should routinely be screened for bone disease. Nevertheless, considering the modest sample size of studies and evidence of publication bias, larger and high-quality studies are required (CRD42023471045).
Mild autonomous cortisol secretion (MACS), often also referred to as subclinical hypercortisolism (SH), is usually associated with an underlying adrenal incidentaloma (AI), an adrenal mass incidentally found during abdomen imaging. Although signs of overt cortisol excess are lacking, subjects with MACS/SH often have features of metabolic syndrome, osteoporosis and fractures. The present systematic
review and meta-analysis showed that the pooled prevalence of any
fractures (vertebral and non–vertebral), vertebral fractures, and osteoporosis/osteopenia in MACS/SH were 43%, 45%, and 50%, respectively. People with adrenal adenomas/incidentalomas and MACS/SH are at a 1.5- to 2-fold higher likelihood of fractures and osteoporosis/osteopenia compared to non–functional adrenal adenomas. Besides, subjects with MACS/SH had significantly lower bone mineral density at lumbar spine and femoral neck than their non–functional counterparts. It is thus imperative to assess bone health in all subjects with MACS/SH.