{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:41:12Z","timestamp":1760128872749,"version":"build-2065373602"},"reference-count":135,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2023,6,24]],"date-time":"2023-06-24T00:00:00Z","timestamp":1687564800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Our aim is to analyse the bone profile in adults with (non-functioning) adrenal incidentalomas (AIs), specifically addressing the impact of autonomous cortisol secretion (ACS). This narrative review, based on a PubMed search from inception to February 2023 (case reports, non-ACS, and other secondary causes of osteoporosis were excluded), included 40 original studies, a total of 3046 patients with female prevalence (female:male ratio of 1921:1125), aged between 20.5 and 95.5 years old. This three decade-based analysis showed that 37 studies provided dual-energy X-ray absorptiometry (DXA) information; another five studies reports results on bone micro-architecture, including trabecular bone score (TBS), spinal deformity index, and high-resolution peripheral quantitative computed tomography; 20 cohorts included data on bone turnover markers (BTMs), while four longitudinal studies followed subjects between 1 and 10.5 years old (surgical versus non-adrenalectomy arms). Post-dexamethasone suppression test (DST) cortisol was inversely associated with bone mineral density (BMD). TBS predicted incidental vertebral fractures (VFx) regardless of BMD, being associated with post-DST cortisol independently of age and BMD. Low BTMs were identified in ACS, but not all studies agreed. An increased prevalence of ACS-related osteoporosis was confirmed in most studies (highest prevalence of 87.5%), as well as of VFx, including in pre-menopause (42.5%), post-menopause (78.6%), and male patients (72.7%) depending on the study, with a 10-fold increased incidental VFx risk up to a 12-fold increased risk after a 2-year follow-up. No specific medication against osteoporosis is indicated in ACS, but adrenalectomy (according to four studies) should be part of the long-term strategy. This bone profile case sample-based study (to our knowledge, one of the largest of its kind) showed that AIs, including the subgroup designated as having ACS, embraces a large panel of osseous complications. The level of evidence remains far from generous; there are still no homogenous results defining ACS and identifying skeletal involvement, which might be a consequence of different investigation clusters underling adrenal and bone assessments over time. However, bone status evaluations and associated therapy decisions remain an essential element of the management of adults with AIs-ACS.<\/jats:p>","DOI":"10.3390\/jcm12134244","type":"journal-article","created":{"date-parts":[[2023,6,26]],"date-time":"2023-06-26T03:14:56Z","timestamp":1687749296000},"page":"4244","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Management of Adrenal Cortical Adenomas: Assessment of Bone Status in Patients with (Non-Functioning) Adrenal Incidentalomas"],"prefix":"10.3390","volume":"12","author":[{"given":"Alexandra-Ioana","family":"Trandafir","sequence":"first","affiliation":[{"name":"Department of Endocrinology, C.I. Parhon National Institute of Endocrinology & Carol Davila Doctoral School, 011863 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mihaela","family":"Stanciu","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Faculty of Medicine, \u201cLucian Blaga\u201d University of Sibiu, 550024 Sibiu, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simona Elena","family":"Albu","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Carol Davila University of Medicine and Pharmacy & University Emergency Hospital, 050474 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vasile Razvan","family":"Stoian","sequence":"additional","affiliation":[{"name":"Department 10\u2014Surgery, General Surgery Department 3, Carol Davila University of Medicine and Pharmacy & University Emergency Hospital, 050474 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Irina","family":"Ciofu","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4530-684X","authenticated-orcid":false,"given":"Cristian","family":"Persu","sequence":"additional","affiliation":[{"name":"Department of Urology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudiu","family":"Nistor","sequence":"additional","affiliation":[{"name":"Department 4\u2014Cardio-Thoracic Pathology, Thoracic Surgery II Discipline, Carol Davila University of Medicine and Pharmacy & Thoracic Surgery Department, \u201cDr. Carol Davila\u201d Central Emergency University Military Hospital, 010825 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8585-3835","authenticated-orcid":false,"given":"Mara","family":"Carsote","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Carol Davila University of Medicine and Pharmacy & C.I. Parhon National Institute of Endocrinology, 011863 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,6,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1007\/s12022-022-09710-8","article-title":"Overview of the 2022 WHO Classification of Adrenal Cortical Tumors","volume":"33","author":"Mete","year":"2022","journal-title":"Endocr. Pathol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"870","DOI":"10.4158\/EP15618.OR","article-title":"Clinical Outcomes in Adrenal Incidentaloma: Experience from one Center","volume":"21","author":"Patrova","year":"2015","journal-title":"Endocr. Pract."},{"key":"ref_3","first-page":"637","article-title":"A Survey on Adrenal Incidentaloma in Italy","volume":"85","author":"Mantero","year":"2000","journal-title":"J. Clin. Endocrinol. 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