ISSN ONLINE: 2558-815X
ISSN PRINT: 1584-9244
ISSN-L: 1584-9244

Menopausal osteoporosis in patients with bilateral adrenal tumors

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Introduction: Bilateral adrenal tumors have a wide area of etiologies but most of the cases are actually incompletely known. In some situations a persistent mild hypercortisolemia associates subclinical Cushing’s syndrome. Menopausal subjects with adrenal masses might be admitted for osteoporosis with a dual component: the lack of estrogens and elevated plasma cortisol.
Metabolic improvement after adrenalectomy involves also the skeleton. However there are cases when surgery is refused and further close follow-up including bone is needed. We introduce 2 cases with a long medical history of both osteoporosis and bilateral adrenal tumors which suggest a potential connection between these two conditions.

Cases: A 63-year female is known since the age of 60 with a right adrenal tumor associating a low plasma ACTH and partial suppression of cortisol after dexamethasone test. At age of 62 a second tumor at the level of left adrenal was identified.
Since the age of 58 she was found with osteoporosis and specific therapy was offered to her, associating the indication of continuing it once the persistent cortisolemia was identified (and surgery refused by the patient).
A 70-year female was treated 8 years with oral bisphosphonates for menopausal osteoporosis (menopause was at 45 years). At age of 68 she was accidentally found with a left adrenal tumor of 2 cm. Despite improvement of Bone Mineral Density to a lumbar L1-4 T-score of -2.3 SD, endocrine profile was consistent for mild endogen glucocorticoid secretion so antiosteoporotic therapy was continued. 1 year later, the suppression of ACTH was stationary while CT scan revealed a second tumor (on the right) of 1.19 by 0.79 cm.

Conclusion: Persistent mild hypercortisolemia- associated bilateral adrenal tumors might change the decision of therapy in cases with long term menopausal or age-related osteoporosis especially if adrenalectomy is not performed. Which is the exact component of bone loss caused by abnormal adrenal profile is difficult to establish but an individual decision is required. Abbreviations: IV = intravenous, cm = centimeter, μg = microgram, CT = computed tomography, BMD = Bone Mineral Density, ACTH = Adrenocorticotropic Hormone, DXM = Dexamethasone

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