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Kim, Beom-Jun; Kwak, Mi Kyung; Ahn, Seong Hee; Kim, Hyeonmok; Lee, Seung Hun; Koh, Jung-Min

2017

ContextDespite the potential detrimental effects of aldosterone excess on bone metabolism, there are discrepancies between fracture risk and bone mass in patients with and without primary aldosteronism (PA).ObjectiveTo clarify the possibility that aldosterone excess may mainly affect bone properties which are not explained by bone mineral density (BMD).Design, Setting, and PatientsAmong 625 consecutive patients with newly diagnosed adrenal incidentaloma, 72 patients with biochemically confirmed PA and 335 patients with nonfunctional adrenal incidentaloma were defined as cases and controls, respectively.ResultsIn women, although there were no significant differences in lumbar spine BMD between groups, the lumbar spine trabecular bone score (TBS) was significantly lower in patients with PA than in controls after adjustment for confounders (P = 0.007). Consistently, plasma aldosterone concentration (PAC) was inversely correlated with lumbar spine TBS (P = 0.028) but not with bone mass in women. Compared with women in the lowest PAC quartile, those in the highest PAC quartile had significantly lower lumbar spine TBS (P = 0.004). Importantly, all these observations in women remained statistically significant following the additional adjustment for lumbar spine BMD in the multivariable model. However, BMD and TBS at the lumbar spine did not differ according to the presence of PA and the level of PAC in men.ConclusionThese findings provide the first clinical evidence that aldosterone excess in PA may contribute to deteriorated bone quality through weak microarchitecture, regardless of bone mass, especially in women.

615-621

Adrenal incidentaloma     Aldosterone     Endocrinology     South Korea