{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T06:05:34Z","timestamp":1789538734219,"version":"build-2803163510"},"reference-count":73,"publisher":"Societatea Romana de Morfologie","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rom J Morphol Embryol"],"published-print":{"date-parts":[[2026,9,15]]},"abstract":"<jats:p>Background: Current guideline-based stratification in the non-secretory adrenal tumors (ADTs) involves the second-day (post-Dexamethasone testing) plasma cortisol (D-C) threshold of  1.8 \u03bcg\/dL to determine a non-functional profile and another one for a mild cortisol secretion (cortisol between 1.8 and 5 \u03bcg\/dL). Objective: To analyze the bone status in terms of mineral metabolism, circulating biomarkers of bone turnover and bone mineral density in menopausal women with ADTs by comparing two population subgroups, according to distinct thresholds for D-C, which are out of the current guidelines (1.4 \u03bcg\/dL and 0.9 \u03bcg\/dL, respectively). Patients, Materials and Methods: A retrospective analysis was conducted in ADT-positive menopausal women. Results: Final analysis included 109 adults: ADT-1 group (52.3%; D-C: \u22641.4 \u03bcg\/dL) vs. ADT-2 group (47.7%; D-C: 1.4\u20135 \u03bcg\/dL) and ADT-3 group (20.2%; D-C: \u22640.9 \u03bcg\/dL) vs. ADT-4 group (79.8%; D-C: 0.9\u20135 \u03bcg\/dL), respectively. ADT-1 group vs. ADT-2 group was at similar age (60.14\u00b18.56 vs. 60.08\u00b111.85 years), menopause duration (13.85\u00b17.41 vs. 14.19\u00b18.54 years), body mass index (30.78\u00b16.20 vs. 29.23\u00b16.73 kg\/m2), and obesity rate (56% vs. 35.9%). Mineral metabolism assays showed no between-group difference. Both groups experienced a vitamin D deficiency according to 25-hydroxyvitamin D (23.69\u00b110.42 vs. 25.35\u00b19.98 ng\/mL, p=0.481). Except for femoral neck T-score within ADT-1 group (-1.22\u00b11.11), all the other dual energy X-ray absorptiometry (DXA) categories were normal. The prevalence of osteoporosis diagnosis was similar: 24.5% vs. 35.4%, with lower fracture rate (3.5% compared to 21.2%, p=0.005). ADT-3 group compared to ADT-4 group showed a similar bone health status. Half of patients suffered from obesity (50% vs. 46.4%, p=0.775). A borderline significance was attributed to a higher total hip T-score in ADT-3 group vs. ADT-4 group (-0.23 vs. -0.87, p=0.06), both with intra-normal values, and a lower fracture rate (0% vs. 14.9%, p=0.053). Osteoporosis diagnosis displayed a statistically significant decrease in the prevalence in ADT-3 group vs. ADT-4 group: 5.6% vs. 35.4% (p=0.042). Conclusions: Menopausal adults with D-C &gt;0.9 \u03bcg\/dL should be mandatory tested for osteoporosis, and those with D-C &gt;1.4 \u03bcg\/dL should be additionally screened for osteoporotic fractures, while age is not different among the subgroups with different cutoffs.<\/jats:p>","DOI":"10.47162\/rjme.67.2.10","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T18:08:14Z","timestamp":1789495694000},"page":"293-300","source":"Crossref","is-referenced-by-count":0,"title":["Alternative cutoffs for cortisol post-Dexamethasone suppression testing: is there a practical point for the bone health evaluation?"],"prefix":"10.47162","volume":"67","author":[{"name":"Department of Occupational Medicine, University of Medicine and Pharmacy of Craiova, Romania","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nina","family":"Ionovici","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra-Ioana","family":"Trandafir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Doctoral School, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dana","family":"Manda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Department of Research, C.I. Parhon National Institute of Endocrinology, Bucharest, Romania","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana-Maria","family":"Gheorghe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Department of Clinical Endocrinology V, C.I. Parhon National Institute of Endocrinology, Bucharest, Romania","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dana Cristina","family":"Terzea","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Department of Pathology, C.I. Parhon National Institute of Endocrinology, Bucharest, Romania; Oncoteam Diagnostics, Bucharest, Romania","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mara","family":"Carsote","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Doctoral School, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Clinical Endocrinology V, C.I. Parhon National Institute of Endocrinology, Bucharest, Romania; Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian","family":"Ciuche","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Department of Thoracic Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"26736","published-online":{"date-parts":[[2026,9,8]]},"reference":[{"key":"ref0","doi-asserted-by":"publisher","unstructured":"\"[1] Macech M, St\u0119pie\u0144 M, Podg\u00f3rska J, Toutounchi S, Koperski \u0141, Barankiewicz J, Bobrowicz M, Kondracka A, Ambroziak U. Natural history of large adrenal tumors. Front Endocrinol (Lausanne), 2026, 17:1774131. https:\/\/doi.org\/10.3389\/fendo.2026.1774131","DOI":"10.3389\/fendo.2026.1774131"},{"key":"ref1","doi-asserted-by":"publisher","unstructured":"[2] Prete A, Abdi L, Canducci M, van den Brandhof EL, Albors-Zumel A, Jenkinson C, Gilligan LC, Zhang Y, Visser L, Chortis V, Najdekr L, Jankevics A, Lloyd GR, Winder CL, Tsagarakis S, Lang K, Macech M, Fell V, Vodanovic ID, Reimondo G, Marina LV, Deutschbein T, Balomenaki M, O'Reilly MW, Bednarczuk T, Dusek T, Diamantopoulos A, Asia M, Kondracka A, Yu K, Masjkur JR, Quinkler M, Ueland G\u00c5, Dennedy MC, Beuschlein F, Tabarin A, Fassnacht M, Ivovic M, Terzolo M, Kastelan D, Young WF Jr, Manolopoulos KN, Ambroziak U, Vassiliadi DA, Bancos I, Sitch AJ, Taylor AE, Tino P, Biehl M, Dunn WB, Arlt W; ENSAT EURINE-ACT Investigators. Endocrine and metabolic determinants of cardiometabolic risk in mild autonomous cortisol secretion. EBioMedicine, 2026, 124:106126. https:\/\/doi.org\/10.1016\/j.ebiom.2026.106126","DOI":"10.1016\/j.ebiom.2026.106126"},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"[3] Favero V, Bernasconi D, Maloberti A, Parazzoli C, Musolino A, Chilton R, Heaney AP, Eller-Vainicher C, Scillitani A, Chiodini I. Cardiometabolic risk parameters in \"nonfunctioning\" adrenal incidentalomas: a systematic review and meta-analysis. J Clin Endocrinol Metab, 2026, 111(2):e619-e629. https:\/\/doi.org\/10.1210\/clinem\/dgaf597","DOI":"10.1210\/clinem\/dgaf597"},{"key":"ref3","doi-asserted-by":"publisher","unstructured":"[4] Ravi Kumar P, Duggempudi SMR, Dash DK, Patro D, Behera SK. Incidentally discovered adrenal mass with mild autonomous cortisol secretion and pheochromocytoma. Cureus, 2026, 18(2):e103247. https:\/\/doi.org\/10.7759\/cureus.103247","DOI":"10.7759\/cureus.103247"},{"key":"ref4","doi-asserted-by":"publisher","unstructured":"[5] Bogdan-Andreescu CF, Bubulac L, Albu CC, Sl\u0103vescu DA, B\u0103n\u0103\u0163eanu AM, Botoac\u0103 O, Mu\u015fat GC, Tudor V, Cadar E, P\u0103curar M. Toward smart salivary diagnostics: a comprehensive review of heavy metal biomarkers and digital risk modeling. Diagnostics (Basel), 2026, 16(4):635. https:\/\/doi.org\/10.3390\/diagnostics16040635","DOI":"10.3390\/diagnostics16040635"},{"key":"ref5","doi-asserted-by":"publisher","unstructured":"[6] Tarbaeva NV, Chevais A, Manaev AV, Beltsevich DG, Platonova NM, Troshina EA, Melnichenko GA, Mokrysheva NG. [Modern capabilities of contrast-enhanced computed tomography in the diagnosis of adrenal adenomas]. Probl Endokrinol (Mosk), 2026, 72(1):23-37. https:\/\/doi.org\/10.14341\/probl13670","DOI":"10.14341\/probl13670"},{"key":"ref6","unstructured":"[7] Poian\u0103 C, Mu\u015fat M, Carsote M, Chiri\u0163\u0103 C. Premenstrual dysphoric disorder: neuroendocrine interferences. Rev Med Chir Soc Med Nat Iasi, 2009, 113(4):996-1000."},{"key":"ref7","doi-asserted-by":"publisher","unstructured":"[8] Cuzino D, Capisizu AS. The transformative role of artificial intelligence in the future of radiology. Rom J Mil Med, 2025, 128(6):528-535. https:\/\/doi.org\/10.55453\/rjmm.2025.128.6.6","DOI":"10.55453\/rjmm.2025.128.6.6"},{"key":"ref8","doi-asserted-by":"publisher","unstructured":"[9] Eilsberger F, Michalski K, Luster M. [Novel imaging techniques for the differential diagnosis of adrenal tumors, pheochromocytomas and paragangliomas]. Chirurgie (Heidelb), 2026. https:\/\/doi.org\/10.1007\/s00104-025-02443-4","DOI":"10.1007\/s00104-025-02443-4"},{"key":"ref9","doi-asserted-by":"publisher","unstructured":"[10] Karsl\u0131 S, \u00c7elik S, \u015eahin Kimyon \u00d6, Turgut S, Aydin H, Ciftci S. Clinical and metabolic outcomes of adrenalectomy vs. conservative management in mild autonomous cortisol secretion. Horm Metab Res, 2026, 58(7):260-265. https:\/\/doi.org\/10.1055\/a-2830-3972","DOI":"10.1055\/a-2830-3972"},{"key":"ref10","doi-asserted-by":"publisher","unstructured":"[11] Yorulmaz EM, Gorgel A, Ozcan S, Kose O, Gorgel SN, Akin Y. Systemic immune-inflammation index as an independent predictor of malignancy in 4-6 cm adrenal incidentalomas. Actas Urol Esp (Engl Ed), 2026, 50(2):501909. https:\/\/doi.org\/10.1016\/j.acuroe.2026.501909","DOI":"10.1016\/j.acuroe.2026.501909"},{"key":"ref11","doi-asserted-by":"publisher","unstructured":"[12] Zambudio-Munuera A, Mill\u00e1n-Ramos I, Guti\u00e9rrez-Tejero F, Arrabal-Polo M\u00c1. [Adrenal incidentaloma with hyperprocalcitoninemia]. Aten Primaria, 2026, 58(5):103472. https:\/\/doi.org\/10.1016\/j.aprim.2026.103472","DOI":"10.1016\/j.aprim.2026.103472"},{"key":"ref12","doi-asserted-by":"publisher","unstructured":"[13] Postole XI, Cimponeriu D, Alexiu-Toma OA, Radu I, Berca L, Eremia IA, Nica S, Nica R. The impact of miRNAs in diabetes mellitus. Rom J Mil Med, 2025, 128(6):508-519. https:\/\/doi.org\/10.55453\/rjmm.2025.128.6.4","DOI":"10.55453\/rjmm.2025.128.6.4"},{"key":"ref13","doi-asserted-by":"publisher","unstructured":"[14] Xie X, Ma SX, Luo XD, Liao DY, Han D, Huang ZP, Chen ZH, Li XP, Li B, Hu SD, Chen YJ, Liu PF, Zheng DZ, Xia H, Liu CD, Zhao SC, Chen MK. Automatic recognition of adrenal incidentalomas using a two-stage cascade network: a multicenter study. Ann Med, 2025, 57(1):2540596. https:\/\/doi.org\/10.1080\/07853890.2025.2540596","DOI":"10.1080\/07853890.2025.2540596"},{"key":"ref14","doi-asserted-by":"publisher","unstructured":"[15] Luk Y, Ip RTH, Lee JN, Fung MMH, Lui DTW, Lang BHH. Prevalence of mild autonomous cortisol secretion in adrenal incidentalomas and the significance of subcentimeter adrenal nodules: a single-center cohort study. Endocr Pract, 2025, 31(12):1576-1584. https:\/\/doi.org\/10.1016\/j.eprac.2025.07.018","DOI":"10.1016\/j.eprac.2025.07.018"},{"key":"ref15","doi-asserted-by":"publisher","unstructured":"[16] Febbraro E, Procopio M, Napoli S, Sola C, Bollati M, Ponzetto F, Aimaretti G, Arvat E, Maccario M, Giordano R, Parasiliti-Caprino M. Cardiometabolic risk in bilateral versus unilateral nonfunctioning adrenal incidentalomas: evidence from a large referral center cohort. Endocr Pract, 2026, 32(7):1115-1123. https:\/\/doi.org\/10.1016\/j.eprac.2026.03.005","DOI":"10.1016\/j.eprac.2026.03.005"},{"key":"ref16","doi-asserted-by":"publisher","unstructured":"[17] De Alcubierre D, Ferrari D, Tomaselli A, Moscucci F, Bonaventura I, Francia A, Vozza E, Lospinuso I, Ettorre E, Hasenmajer V, Minnetti M, Sbardella E, Tenuta M, Morelli S, Paganini AM, Isidori AM, Pofi R. Long-term cardiac effects of adrenalectomy versus surveillance in mild cortisol excess: 5-year results from the prospective ITACA study. Eur J Endocrinol, 2026, 194(2):170-184. https:\/\/doi.org\/10.1093\/ejendo\/lvag018","DOI":"10.1093\/ejendo\/lvag018"},{"key":"ref17","doi-asserted-by":"publisher","unstructured":"[18] Mitrica M, Vasiliu O, Plesa A, Sirbu OM. Multinodular and vacuolating neuronal tumor - challenges and perspectives. Rom J Mil Med, 2025, 128(1):10-16. https:\/\/doi.org\/10.55453\/rjmm.2025.128.1.2","DOI":"10.55453\/rjmm.2025.128.1.2"},{"key":"ref18","doi-asserted-by":"publisher","unstructured":"[19] Yener S, Tuna G, Sahin H, Adiyaman SC, Saydam BO, Baris M, Islekel GH. Estimation of cortisol exposure in patients with adrenal incidentalomas. BMC Endocr Disord, 2025, 25(1):266. https:\/\/doi.org\/10.1186\/s12902-025-02090-0","DOI":"10.1186\/s12902-025-02090-0"},{"key":"ref19","doi-asserted-by":"publisher","unstructured":"[20] Vasiliu O, Panea CA, Mangalagiu AG, Petrescu BM, C\u00e2ndea CA, Manea MM, Ciobanu AM, S\u00eerbu CA, Mitric\u0103 M. Case management of delirium in patients with major neurocognitive disorders. Rom J Mil Med, 2025, 128(1):67-77. https:\/\/doi.org\/10.55453\/rjmm.2025.128.1.9","DOI":"10.55453\/rjmm.2025.128.1.9"},{"key":"ref20","doi-asserted-by":"publisher","unstructured":"[21] G\u00fcne\u015f E, G\u00fcne\u015f M, Kaya M\u0130, Y\u00fcksel M, Memet S, Kibar B, Kaya C, Tufano\u011flu FH, Oral B. Number of comorbidities predicts adrenal incidentaloma and autonomic cortisol secretion in obese individuals: a two-center cohort study. Endocrine, 2025, 90(2):982-994. https:\/\/doi.org\/10.1007\/s12020-025-04355-z","DOI":"10.1007\/s12020-025-04355-z"},{"key":"ref21","doi-asserted-by":"publisher","unstructured":"[22] Manea MM, Dragos D, Ghenu MI, Enache II, Stoican IC, Ciulavu C, Vasiliu O, Sirbu CA, Tuta S. The neurocardiogenic impact of ischemic stroke: intricacies of cardiac enzymes and the vegetative system. Rom J Mil Med, 2025, 128(1):36-42. https:\/\/doi.org\/10.55453\/rjmm.2025.128.1.5","DOI":"10.55453\/rjmm.2025.128.1.5"},{"key":"ref22","doi-asserted-by":"publisher","unstructured":"[23] Araujo-Castro M, Calatayud Guti\u00e9rrez M, Parra Ram\u00edrez P, Men\u00e9ndez Torre E, de Miguel P, Paja M, Mangas M\u00c1, Lamas Oliveira C, Hanzu FA. Update of the guidelines on the management of adrenal incidentaloma from the Adrenal Group of the Spanish Society of Endocrinology and Nutrition (SEEN). Endocrine, 2025, 90(2):453-466. https:\/\/doi.org\/10.1007\/s12020-025-04408-3","DOI":"10.1007\/s12020-025-04408-3"},{"key":"ref23","doi-asserted-by":"publisher","unstructured":"[24] Savoie PH, Murez T, Rocher L, Neuville P, Escoffier A, Fl\u00e9chon A, Branger N, Camparo P, Roupr\u00eat M. French AFU Cancer Committee Guidelines - update 2024-2026: assessment of an adrenal incidentaloma and oncological management. Fr J Urol, 2024, 34(12):102748. https:\/\/doi.org\/10.1016\/j.fjurol.2024.102748","DOI":"10.1016\/j.fjurol.2024.102748"},{"key":"ref24","doi-asserted-by":"publisher","unstructured":"[25] Janiak K, J\u00f3zwik-Plebanek K, Kami\u0144ski G. Recent guidelines for diagnostic and therapeutic management of accidentally detected adrenal tumours (incidentaloma) in adults. Endokrynol Pol, 2024, 75(4):385-394. https:\/\/doi.org\/10.5603\/ep.100278","DOI":"10.5603\/ep.100278"},{"key":"ref25","doi-asserted-by":"publisher","unstructured":"[26] Fassnacht M, Tsagarakis S, Terzolo M, Tabarin A, Sahdev A, Newell-Price J, Pelsma I, Marina L, Lorenz K, Bancos I, Arlt W, Dekkers OM. European Society of Endocrinology clinical practice guidelines on the management of adrenal incidentalomas, in collaboration with the European Network for the Study of Adrenal Tumors. Eur J Endocrinol, 2023, 189(1):G1-G42. https:\/\/doi.org\/10.1093\/ejendo\/lvad066","DOI":"10.1093\/ejendo\/lvad066"},{"key":"ref26","doi-asserted-by":"publisher","unstructured":"[27] Araujo-Castro M, Parra Ram\u00edrez P, Mart\u00edn Rojas-Marcos P, Garc\u00eda Centeno R, Gracia Gimeno P, Tom\u00e9 Fern\u00e1ndez-Ladreda M, Sampedro N\u00fa\u00f1ez MA, Higueruela C, Robles L\u00e1zaro C. Nonfunctioning adrenal incidentalomas with cortisol post-Dexamethasone suppression test >0.9 \u03bcg\/dL have a higher prevalence of cardiovascular disease than those with values \u22640.9 \u03bcg\/dL. Endocrine, 2023, 79(2):384-391. https:\/\/doi.org\/10.1007\/s12020-022-03228-z","DOI":"10.1007\/s12020-022-03228-z"},{"key":"ref27","doi-asserted-by":"publisher","unstructured":"[28] Favero V, Cairoli E, Eller-Vainicher C, Morelli V, Salcuni AS, Della Casa S, Muscogiuri G, Columbu C, Pugliese F, Corbetta S, Persani L, Scillitani A, Chiodini I. Fragility fractures and cortisol secretion in patients with nonfunctioning adrenal incidentalomas. J Endocr Soc, 2024, 8(10):bvae144. https:\/\/doi.org\/10.1210\/jendso\/bvae144","DOI":"10.1210\/jendso\/bvae144"},{"key":"ref28","doi-asserted-by":"publisher","unstructured":"[29] Favero V, Aresta C, Parazzoli C, Cairoli E, Eller-Vainicher C, Palmieri S, Salcuni AS, Arosio M, Persani L, Scillitani A, Morelli V, Chiodini I. The degree of cortisol secretion is associated with diabetes mellitus and hypertension in patients with nonfunctioning adrenal tumors. Cardiovasc Diabetol, 2023, 22(1):102. https:\/\/doi.org\/10.1186\/s12933-023-01836-1","DOI":"10.1186\/s12933-023-01836-1"},{"key":"ref29","doi-asserted-by":"publisher","unstructured":"[30] Favero V, Eller-Vainicher C, Morelli V, Scillitani A, Chiodini I. Lowering the Dexamethasone suppression test cut-off: is it time yet? J Endocrinol Invest, 2025, 48(12):2831-2843. https:\/\/doi.org\/10.1007\/s40618-025-02679","DOI":"10.1007\/s40618-025-02679-1"},{"key":"ref30","doi-asserted-by":"publisher","unstructured":"[31] Androulakis II, Kaltsas GA, Kollias GE, Markou AC, Gouli AK, Thomas DA, Alexandraki KI, Papamichael CM, Hadjidakis DJ, Piaditis GP. Patients with apparently nonfunctioning adrenal incidentalomas may be at increased cardiovascular risk due to excessive cortisol secretion. J Clin Endocrinol Metab, 2014, 99(8):2754-2762. https:\/\/doi.org\/10.1210\/jc.2013-4064","DOI":"10.1210\/jc.2013-4064"},{"key":"ref31","doi-asserted-by":"publisher","unstructured":"[32] Morelli V, Reimondo G, Giordano R, Della Casa S, Policola C, Palmieri S, Salcuni AS, Dolci A, Mendola M, Arosio M, Ambrosi B, Scillitani A, Ghigo E, Beck-Peccoz P, Terzolo M, Chiodini I. Long-term follow-up in adrenal incidentalomas: an Italian multicenter study. J Clin Endocrinol Metab, 2014, 99(3):827-834. https:\/\/doi.org\/10.1210\/jc.2013-3527","DOI":"10.1210\/jc.2013-3527"},{"key":"ref32","unstructured":"[33] Carsote M, Paduraru DN, Nica AE, Valea A. Parathyroidectomy: is vitamin D a player for a good outcome? J Med Life, 2016, 9(4):348-352."},{"key":"ref33","doi-asserted-by":"publisher","unstructured":"[34] Kanis JA, Cooper C, Rizzoli R, Reginster JY; Scientific Advisory Board of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) and the Committees of Scientific Advisors and National Societies of the International Osteoporosis Foundation (IOF). Executive summary of the European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Calcif Tissue Int, 2019, 104(3):235-238. https:\/\/doi.org\/10.1007\/s00223-018-00512-x","DOI":"10.1007\/s00223-018-00512-x"},{"key":"ref34","doi-asserted-by":"publisher","unstructured":"[35] Kanis JA, Cooper C, Rizzoli R, Reginster JY; Scientific Advisory Board of the European Society for Clinical and Economic Aspects of Osteoporosis (ESCEO) and the Committees of Scientific Advisors and National Societies of the International Osteoporosis Foundation (IOF). European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int, 2019, 30(1):3-44. https:\/\/doi.org\/10.1007\/s00198-018-4704-5","DOI":"10.1007\/s00198-018-4704-5"},{"key":"ref35","unstructured":"[36] Dumitru N, Ghemigian A, Carsote M, Albu SE, Terzea D, Valea A. Thyroid nodules after initial evaluation by primary health care practitioners: an ultrasound pictorial essay. Arch Balk Med Union, 2016, 51(3):434-438."},{"key":"ref36","doi-asserted-by":"publisher","unstructured":"[37] Behanova M, Sokhan A, Haschka J, Zandieh S, Salzlechner C, Ljuhar R, Zwerina J, Kocijan R. AI-supported opportunistic detection of vertebral fractures on routine CT scans: diagnostic performance and clinical relevance. Bone, 2026, 203:117735. https:\/\/doi.org\/10.1016\/j.bone.2025.117735","DOI":"10.1016\/j.bone.2025.117735"},{"key":"ref37","unstructured":"[38] Valea A, Ghervan C, Morar A, Pop DD, Carsote M, Albu SE, Georgescu CE, Chiorean A. Hashimoto's thyroiditis and breast cancer: coincidence or correlation? Arch Balk Med Union, 2016, 51(1):125-128."},{"key":"ref38","doi-asserted-by":"publisher","unstructured":"[39] Hanly A, Gyftopoulos S, Pelzl CE, He W, Chang CY. Opportunistic screening for osteoporosis: validation study for L1 bone density measurements using contrast-enhanced chest and abdominal CTs. Skeletal Radiol, 2025, 54(9):1887-1895. https:\/\/doi.org\/10.1007\/s00256-025-04892-8","DOI":"10.1007\/s00256-025-04892-8"},{"key":"ref39","doi-asserted-by":"publisher","unstructured":"[40] Sp\u00e5ngeus A, Bjerner T, Lindblom M, G\u00f6tz C, Hummer A, Salzlechner C, Woisetschl\u00e4ger M. Breaking the silence: AI's contribution to detecting vertebral fractures in opportunistic CT scans in the elderly - a validation study. Arch Osteoporos, 2025, 20(1):42. https:\/\/doi.org\/10.1007\/s11657-025-01524-5","DOI":"10.1007\/s11657-025-01524-5"},{"key":"ref40","unstructured":"[41] Valea A, Carsote M, Moldovan C, Georgescu C. Chronic autoimmune thyroiditis and obesity. Arch Balk Med Union, 2018, 53(1):64-69."},{"key":"ref41","doi-asserted-by":"publisher","unstructured":"[42] Ahn SH, Jung KY, Ahn CH, Park SS, Lee YB, Hong AR, Ku EJ, Kim HJ, Hong S, Koh JM, Kim JH, Lee SH. Time-dependent increase in cortisol after 1-mg overnight Dexamethasone suppression test in adrenal incidentalomas. J Endocr Soc, 2025, 10(1):bvaf197. https:\/\/doi.org\/10.1210\/jendso\/bvaf197","DOI":"10.1210\/jendso\/bvaf197"},{"key":"ref42","doi-asserted-by":"publisher","unstructured":"[43] Kumar AL, Dream S, Shaik T, Doffek K, Conrardy R, Findling JW, Carroll TB, Zhang CD, Evans DB, Wang TS. The impact of adrenalectomy on metabolic outcomes of patients with mild autonomous cortisol secretion defined by low-dose Dexamethasone suppression testing. Surgery, 2026, 189:109775. https:\/\/doi.org\/10.1016\/j.surg.2025.109775","DOI":"10.1016\/j.surg.2025.109775"},{"key":"ref43","doi-asserted-by":"publisher","unstructured":"[44] Rao A, Phadte A, Ban A, Memon SS, Karlekar M, Lila AR, Sarathi V, Kansal N, Barnabas R, Badhe PV, Fernandes G, Rege S, Prakash G, Menon S, Shah N, Bandgar T. Serum steroid profiling by LC-MS\/MS in distinguishing adrenocortical carcinoma from other indeterminate adrenal masses. J Steroid Biochem Mol Biol, 2026, 258:106937. https:\/\/doi.org\/10.1016\/j.jsbmb.2026.106937","DOI":"10.1016\/j.jsbmb.2026.106937"},{"key":"ref44","doi-asserted-by":"publisher","unstructured":"[45] Ramasamy I. Clinical application of steroid profiles and their interpretation in adrenal disorders. Diagnostics (Basel), 2026, 16(3):381. https:\/\/doi.org\/10.3390\/diagnostics16030381","DOI":"10.3390\/diagnostics16030381"},{"key":"ref45","doi-asserted-by":"publisher","unstructured":"[46] Laugesen K, Hansen SB, Bislev LS, J\u00f8rgensen JOL, Ladefoged SA. Dynamic testing of cortisol in consecutive patients with suspected adrenal disorders: a comparison of Elecsys Cortisol II and LC-MS\/MS. Endocr Connect, 2026, 15(1):e250600. https:\/\/doi.org\/10.1530\/EC-25-0600","DOI":"10.1530\/EC-25-0600"},{"key":"ref46","doi-asserted-by":"publisher","unstructured":"[47] Prinzi A, Lombardo AM, Finocchiaro S, Galvano A, Vella V, Frasca F, Malandrino P. Expanding the clinical profile of mild autonomous cortisol secretion: new diagnostic markers and emerging complications. Endocr Pract, 2026, 32(1):46-52. https:\/\/doi.org\/10.1016\/j.eprac.2025.09.009","DOI":"10.1016\/j.eprac.2025.09.009"},{"key":"ref47","doi-asserted-by":"publisher","unstructured":"[48] Pinto L, Donato S. Mild autonomous cortisol secretion: diagnosis. Vitam Horm, 2026, 132:243-272. https:\/\/doi.org\/10.1016\/bs.vh.2026.02.005","DOI":"10.1016\/bs.vh.2026.02.005"},{"key":"ref48","doi-asserted-by":"publisher","unstructured":"[49] Enache II, Dragos D, Stoican CI, Naum R, Guberna SM, Manea MM. Oxidative stress and nutritional antioxidants in neurological diseases. Rom J Mil Med, 2025, 128(3):215-224. https:\/\/doi.org\/10.55453\/rjmm.2025.128.3.5","DOI":"10.55453\/rjmm.2025.128.3.5"},{"key":"ref49","doi-asserted-by":"publisher","unstructured":"[50] Kabbani M, Berber E. Management approach of adrenal incidentaloma. J Laparoendosc Adv Surg Tech A, 2026, 36(7):511-516. https:\/\/doi.org\/10.1177\/10926429261443897","DOI":"10.1177\/10926429261443897"},{"key":"ref50","doi-asserted-by":"publisher","unstructured":"[51] Sandru F, Dumitrascu MC, Albu SE, Carsote M, Valea A. Hyperpigmentation and ACTH - an overview of literature. Rom Med J, 2019, 66(4):309-312. https:\/\/doi.org\/10.37897\/RMJ.2019.4.2","DOI":"10.37897\/RMJ.2019.4.2"},{"key":"ref51","doi-asserted-by":"publisher","unstructured":"[52] Cyra\u0144ska-Chyrek E, Grzymis\u0142awska M, Rucha\u0142a M. Diagnostic pitfalls of adrenal incidentaloma. Endokrynol Pol, 2017, 68(3):360-377. https:\/\/doi.org\/10.5603\/EP.2017.0028","DOI":"10.5603\/EP.2017.0028"},{"key":"ref52","doi-asserted-by":"publisher","unstructured":"[53] Ro\u015fca AM, Coman SA, Costache AC, Costache DO. The role of ultrasonography in dermatology. Rom J Mil Med, 2025, 128(2):107-111. https:\/\/doi.org\/10.55453\/rjmm.2025.128.2.3","DOI":"10.55453\/rjmm.2025.128.2.3"},{"key":"ref53","doi-asserted-by":"publisher","unstructured":"[54] Chiodini I, Morelli V. Subclinical hypercortisolism: how to deal with it? Front Horm Res, 2016, 46:28-38. https:\/\/doi.org\/10.1159\/000443862","DOI":"10.1159\/000443862"},{"key":"ref54","unstructured":"[55] Nicola Marioara OM, Popescu M, Vl\u0103doianu CN, Carlig V, Carsote M, Ghenea AE. Study of cognitive dysfunctions in thyroid pathology. Curr Health Sci J, 2021, 47(2):256-262. https:\/\/doi.org\/10.12865\/CHSJ.47.02.16"},{"key":"ref55","doi-asserted-by":"publisher","unstructured":"[56] Walter T, Stark E, Soule S, Gabrielson S. Is a reduction of contralateral adrenal volume assessed by CT volumetry a predictor of autonomous cortisol secretion in patients with adrenal incidentalomas? J Med Imaging Radiat Oncol, 2026, Mar 26. https:\/\/doi.org\/10.1111\/1754-9485.70090","DOI":"10.1111\/1754-9485.70090"},{"key":"ref56","doi-asserted-by":"publisher","unstructured":"[57] Manea MM, Dragos D, Ghenu MI, Enache II, Stoican IC, Ciulavu C, Vasiliu O, Sirbu CA, Tuta S. The neurocardiogenic impact of ischemic stroke: intricacies of cardiac enzymes and the vegetative system. Rom J Mil Med, 2025, 128(1):36-42. https:\/\/doi.org\/10.55453\/rjmm.2025.128.1.5","DOI":"10.55453\/rjmm.2025.128.1.5"},{"key":"ref57","doi-asserted-by":"publisher","unstructured":"[58] Pipernea R, Popa FL, Ciortea VM, Irsay L, Ungur RA, Pintea AL, Iliescu MG, Cip\u0103ian RC, Stanciu M. The role of rehabilitation and anabolic treatment in severe osteoporosis associated with significant vitamin D deficiency - case report. Balneo PRM Res J, 2023, 14(1):539. https:\/\/doi.org\/10.12680\/balneo.2023.539","DOI":"10.12680\/balneo.2023.539"},{"key":"ref58","doi-asserted-by":"publisher","unstructured":"[59] Arthurs L, Schumm M, Curcio P, Gajic Z, Petrocelli R, Taffel M, Raghunathan R, McAllister-Nevins O, Chan C, Patel K, Liou R, Prescott J, Allendorf J, Suh I. Can virtual noncontrast computed tomography improve the diagnostic uncertainty of adrenal incidentalomas? Surgery, 2026, 191:110038. https:\/\/doi.org\/10.1016\/j.surg.2025.110038","DOI":"10.1016\/j.surg.2025.110038"},{"key":"ref59","doi-asserted-by":"publisher","unstructured":"[60] Nica S, Sionel R, M\u0103ciuc\u0103 R, Csutak O, Cimponeriu D, Ciobica ML, Nica MI, Chelu I, Radu I, Toma M. Gender-dependent associations between digit ratio and genetic polymorphisms, BMI, and reproductive factors. Rom J Mil Med, 2025, 128(1):78-86. https:\/\/doi.org\/10.55453\/rjmm.2025.128.1.10","DOI":"10.55453\/rjmm.2025.128.1.10"},{"key":"ref60","doi-asserted-by":"publisher","unstructured":"[61] Jenkin B, Zmijewski PV. Invited Commentary: The future is now: artificial intelligence and adrenal incidentaloma characterization. J Am Coll Surg, 2026, 242(5):1302-1303. https:\/\/doi.org\/10.1097\/XCS.0000000000001720","DOI":"10.1097\/XCS.0000000000001720"},{"key":"ref61","unstructured":"[62] Dumitrascu T, Preda E, Ionescu M. Emphysematous cystitis: an unreported complication after pancreaticoduodenectomy. Med Surg J (Rev Med Chir Soc Med Nat Iasi), 2015, 119(1):166-169."},{"key":"ref62","doi-asserted-by":"publisher","unstructured":"[63] Kostek M, McLeod C, Kasmirski J, Negrete H, Tridandapani S, Cochran M, Osborne JD, Gillis A, Chen H, Lindeman B. Predictive model for mild autonomous cortisol secretion in patients evaluated in artificial intelligence-driven adrenal incidentaloma clinic. J Am Coll Surg, 2026, 242(5):1290-1302. https:\/\/doi.org\/10.1097\/XCS.0000000000001827","DOI":"10.1097\/XCS.0000000000001827"},{"key":"ref63","doi-asserted-by":"publisher","unstructured":"[64] Tanase M, Irava BS, Cirstea JO, Samie H. Multiple intestinal neuroendocrine tumors: a literature review and case report. Rom J Mil Med, 2025, 128(4):343-349. https:\/\/doi.org\/10.55453\/rjmm.2025.128.4.9","DOI":"10.55453\/rjmm.2025.128.4.9"},{"key":"ref64","doi-asserted-by":"publisher","unstructured":"[65] Basmaci N, Aksun S, Yildiz BO. Assessing the informatics utility of artificial intelligence chatbots for patient and clinician support: the case of adrenal incidentaloma. Endocrine, 2026, 91(1):34. https:\/\/doi.org\/10.1007\/s12020-025-04491-6","DOI":"10.1007\/s12020-025-04491-6"},{"key":"ref65","doi-asserted-by":"publisher","unstructured":"[66] Florescu AG, Pucerea SA, Floria M, Rusu E, Cuiban E, Jinga M, Galrinho RD, Stanciu SM. Targeting heart disease in cardiovascular-kidney-metabolic syndrome: a review of novel therapeutic approaches with prognostic and quality-of-life impact. Rom J Mil Med, 2025, 128(6):554-565. https:\/\/doi.org\/10.55453\/rjmm.2025.128.6.9","DOI":"10.55453\/rjmm.2025.128.6.9"},{"key":"ref66","doi-asserted-by":"publisher","unstructured":"[67] Ba\u015f Aksu \u00d6, Ayd\u0131n RF, G\u00f6k\u00e7ay Canpolat A, Demir \u00d6, \u015eahin M, Emral R, G\u00fcll\u00fc S. Artificial intelligence in endocrine practice: comparing ChatGPT, Gemini, and Claude for adrenal incidentaloma care. J Endocrinol Invest, 2026, 49(1):69-79. https:\/\/doi.org\/10.1007\/s40618-025-02715-0","DOI":"10.1007\/s40618-025-02715-0"},{"key":"ref67","doi-asserted-by":"publisher","unstructured":"[68] Porr C, Harris DM, Vidrighin A, Catana A, Diaconu C, Preda EM, Popa ML, Berghea EC. Etoricoxib-induced fixed erythema. J Clin Med, 2025, 14(23):8504. https:\/\/doi.org\/10.3390\/jcm14238504","DOI":"10.3390\/jcm14238504"},{"key":"ref68","doi-asserted-by":"publisher","unstructured":"[69] Bubulac L, Gheorghe IR, Ungureanu E, Bogdan-Andreescu CF, Albu CC, Gheorghe CM, Mu\u015fat O, Eremia IA, Panea CA, Burcea A. Promoting re-epithelialization in diabetic foot wounds using integrative therapeutic approaches. Bioengineering (Basel), 2025, 12(10):1053. https:\/\/doi.org\/10.3390\/bioengineering12101053","DOI":"10.3390\/bioengineering12101053"},{"key":"ref69","unstructured":"[70] Olar L, Mitru\u0163 P, Florou C, M\u0103l\u0103escu GD, Predescu OI, Rogozea LM, Mogoant\u0103 L, Ionovici N, Pirici I. Evaluation of Helicobacter pylori infection in patients with eso-gastro-duodenal pathology. Rom J Morphol Embryol, 2017, 58(3):809-815."},{"key":"ref70","doi-asserted-by":"publisher","unstructured":"[71] Cioppi F, Orioli T, Cantini G, Ercolino T, Cioppi F, Assi\u00e9 G, Jouinot A, Dedonno AA, Santi R, de Krijger RR, Maggi M, Benelli M, Canu L, Nesi G, Luconi M. In-depth genetic and molecular characterization of unilateral coexisting adrenal cortical adenoma and carcinoma in the context of MEN1 syndrome. Endocr Pathol, 2026, 37(1):14. https:\/\/doi.org\/10.1007\/s12022-026-09908-0","DOI":"10.1007\/s12022-026-09908-0"},{"key":"ref71","doi-asserted-by":"publisher","unstructured":"[72] Ijacu AM, Gagiu LG, Staicu IM, Zugravu C, Constantin C. Non-alcoholic steatohepatitis diagnosis and treatment - current concepts. Rom J Mil Med, 2025, 128(1):3-9. https:\/\/doi.org\/10.55453\/rjmm.2025.128.1.1","DOI":"10.55453\/rjmm.2025.128.1.1"},{"key":"ref72","doi-asserted-by":"publisher","unstructured":"[73] Itani M, Jacob S, Ludwig DR, Hoegger MJ, Brunt LM, Pandian TK, Bancos I, Genere N. Adrenal lesions in young adults: variability in radiology reporting and implications for clinical evaluation. Abdom Radiol (NY), 2026, Jun 19. https:\/\/doi.org\/10.1007\/s00261-026-05606-x\"","DOI":"10.1007\/s00261-026-05606-x"}],"container-title":["Romanian Journal of Morphology and Embryology"],"original-title":[],"link":[{"URL":"https:\/\/rjme.ro\/RJME\/resources\/files\/670226293300.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T05:44:48Z","timestamp":1789537488000},"score":1,"resource":{"primary":{"URL":"https:\/\/rjme.ro\/archive\/67\/2\/10\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,8]]},"references-count":73,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,9,12]]},"published-print":{"date-parts":[[2026,9,12]]}},"URL":"https:\/\/doi.org\/10.47162\/rjme.67.2.10","relation":{},"ISSN":["1220-0522","2066-8279"],"issn-type":[{"value":"1220-0522","type":"print"},{"value":"2066-8279","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,8]]}}}