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<p>Cortisol-secreting adrenal incidentalomas have been linked to a variety of metabolic comorbidities, as well as impaired bone health. The most recent guidelines on adrenal incidentalomas have refined the diagnosis of mild autonomous cortisol secretion (MACS), now based on a serum cortisol level above 1.8&#xa0;μg/dL (50 nmol/L) following the 1-mg dexamethasone suppression test (1 mg-DST), without further stratification. However, the true prevalence of osteoporosis and fragility fractures in this population remains unclear, largely due to different 1 mg-DST thresholds used in previous studies. This review aims to offer an updated overview on the skeletal effects of MACS, with a particular emphasis on fracture risk and changes in bone density and microarchitecture, in the context of MACS-related osteoporosis. As this field remains underexplored, further studies are needed to better understand and manage this condition.</p>

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Fragilità ossea nella secrezione autonoma di cortisolo (MACS)

  • 期刊论文

  • 发表日期：

    2025年10月21日

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  • Kimberly Coscia,
  • Sara Capra,
  • Guido Zavatta,
  • Guido Di Dalmazi

摘要

Cortisol-secreting adrenal incidentalomas have been linked to a variety of metabolic comorbidities, as well as impaired bone health. The most recent guidelines on adrenal incidentalomas have refined the diagnosis of mild autonomous cortisol secretion (MACS), now based on a serum cortisol level above 1.8 μg/dL (50 nmol/L) following the 1-mg dexamethasone suppression test (1 mg-DST), without further stratification. However, the true prevalence of osteoporosis and fragility fractures in this population remains unclear, largely due to different 1 mg-DST thresholds used in previous studies. This review aims to offer an updated overview on the skeletal effects of MACS, with a particular emphasis on fracture risk and changes in bone density and microarchitecture, in the context of MACS-related osteoporosis. As this field remains underexplored, further studies are needed to better understand and manage this condition.