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Objective <p>To compare lumbar vertebral trabecular attenuation using CT-based Hounsfield unit (HU) measurements among patients with adrenal incidentalomas (AIs) with mild autonomous cortisol secretion (MACS), non-functioning adrenal incidentalomas (NFAIs), and controls.</p> Materials and Methods <p>This retrospective study included 507 patients with AIs who underwent non-contrast abdominal CT. The study sample comprised 121 patients divided into NFAI [cortisol ≤ 1.8&#xa0;µg/dL following dexamethasone suppression test (DST); <i>n</i> = 76] and MACS (cortisol &gt; 1.8&#xa0;µg/dL following DST; <i>n</i> = 45) groups. The control group consisted of 48 age- and gender-matched patients. Two radiologists independently measured trabecular HU values in L1–L5 vertebrae. Predictors of low bone mineral density (BMD) (L1 HU &lt; 110) were evaluated using multivariate analyses.</p> Results <p>A total of 169 patients (mean age, 59 years ± 10 [SD], 50 men) were evaluated. No significant differences existed between groups in age or gender. Mean L1 and L2 HU values were significantly lower in the MACS group (L1: <i>p</i> = 0.027; L2: <i>p</i> = 0.014). Inter-observer reliability was excellent (ICC: 0.932–0.982). A strong correlation was observed between mean L1 HU and lumbar DXA T-score (<i>r</i> = 0.895; <i>p</i> &lt; 0.001). Multivariate analysis identified age, parathyroid hormone level, and patient group as independent predictors of L1 HU &lt; 110. Low BMD risk was significantly lower in the NFAI group (OR = 0.232; <i>p</i> = 0.009).</p> Conclusions <p>MACS was associated with low trabecular bone attenuation in the upper lumbar vertebrae. Opportunistic CT screening may contribute to bone health risk stratification in AI patients without additional radiation exposure.</p>

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Opportunistic CT Screening for Lumbar Vertebral Trabecular Attenuation in Adrenal Incidentaloma Patients with Mild Autonomous Cortisol Secretion

  • 期刊论文

  • 发表日期：

    2026年7月8日

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  • Ahmet Faruk Gürbüz,
  • Süleyman Uluçay,
  • Cemal Kaştan,
  • İsmail Özgül,
  • Nusret Yılmaz,
  • Ayşe Keven,
  • Sadi Elasan,
  • Can Çevikol,
  • Ahmet Gökhan Arslan

摘要

Objective

To compare lumbar vertebral trabecular attenuation using CT-based Hounsfield unit (HU) measurements among patients with adrenal incidentalomas (AIs) with mild autonomous cortisol secretion (MACS), non-functioning adrenal incidentalomas (NFAIs), and controls.

Materials and Methods

This retrospective study included 507 patients with AIs who underwent non-contrast abdominal CT. The study sample comprised 121 patients divided into NFAI [cortisol ≤ 1.8 µg/dL following dexamethasone suppression test (DST); n = 76] and MACS (cortisol > 1.8 µg/dL following DST; n = 45) groups. The control group consisted of 48 age- and gender-matched patients. Two radiologists independently measured trabecular HU values in L1–L5 vertebrae. Predictors of low bone mineral density (BMD) (L1 HU < 110) were evaluated using multivariate analyses.

Results

A total of 169 patients (mean age, 59 years ± 10 [SD], 50 men) were evaluated. No significant differences existed between groups in age or gender. Mean L1 and L2 HU values were significantly lower in the MACS group (L1: p = 0.027; L2: p = 0.014). Inter-observer reliability was excellent (ICC: 0.932–0.982). A strong correlation was observed between mean L1 HU and lumbar DXA T-score (r = 0.895; p < 0.001). Multivariate analysis identified age, parathyroid hormone level, and patient group as independent predictors of L1 HU < 110. Low BMD risk was significantly lower in the NFAI group (OR = 0.232; p = 0.009).

Conclusions

MACS was associated with low trabecular bone attenuation in the upper lumbar vertebrae. Opportunistic CT screening may contribute to bone health risk stratification in AI patients without additional radiation exposure.