{"doi":"10.1210/clinem/dgaa120","title":"The Impact of Mild Autonomous Cortisol Secretion on Bone Turnover Markers","abstract":"CONTEXT: Several studies have reported increased risk of fragility fractures in patients with mild autonomous cortisol secretion (MACS), discordant to the degree of bone density deterioration. OBJECTIVE: To evaluate the effect of MACS on bone metabolism in patients with adrenal adenomas. DESIGN: Cross-sectional study with prospective enrollment, 2014-2019. SETTING: Referral center. PATIENTS: 213 patients with adrenal adenomas: 22 Cushing syndrome (CS), 92 MACS and 99 nonfunctioning adrenal tumors (NFAT). MAIN OUTCOME MEASURES: Osteocalcin, procollagen I intact N-terminal (PINP), C-terminal telopeptide (CTX), sclerostin. RESULTS: Patients with CS demonstrated lower markers of bone formation compared with patients with MACS and NFAT (CS vs MACS vs NFAT: mean osteocalcin 14.8 vs 20.1 vs 21.3 ng/mL [P < 0.0001]; mean PINP 34.8 vs 48.7 vs 48.5 µg/L [P = 0.003]). Severity of cortisol excess was inversely associated with sclerostin (CS vs MACS vs NFAT: mean sclerostin 419 vs 538 vs 624 ng/L, [P < 0.0001]). In a multivariable model of age, sex, body mass index, cortisol, and bone turnover markers, sclerostin was a significant predictor of low bone mass in patients with MACS (OR 0.63 [CI 95%, 0.40-0.98] for each 100 ng/L of sclerostin increase).After adrenalectomy, osteocalcin, CTX, and sclerostin increased by a mean difference of 6.3 ng/mL, 0.12 ng/mL, and 171 pg/mL (P = 0.02 for all), respectively. CONCLUSIONS: Lower sclerostin level in patients with MACS reflects a reduction in osteocyte function or number associated with exposure to chronic cortisol excess. Increase in bone turnover markers after adrenalectomy suggests restoration of favorable bone metabolism.","journal":"The Journal of Clinical Endocrinology & Metabolism","year":2020,"id":94662,"datarank":0.5456379239589579,"base_score":3.6375861597263857,"endowment":3.6375861597263857,"self_citation_contribution":0.5456379239589579,"citation_network_contribution":0.0,"self_endowment_contribution":0.5456379239589579,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":37,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9172,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":239606,"name":"Danae A. Delivanis","orcid":"0000-0003-4868-0423","position":1,"is_corresponding":false},{"id":472352,"name":"Melinda Thomas","orcid":null,"position":2,"is_corresponding":false},{"id":239619,"name":"William F. Young","orcid":"0000-0001-5481-4884","position":3,"is_corresponding":false},{"id":233684,"name":"Sundeep Khosla","orcid":"0000-0002-2936-4372","position":4,"is_corresponding":false},{"id":241940,"name":"Matthew T. Drake","orcid":"0000-0002-3662-7345","position":5,"is_corresponding":false},{"id":239586,"name":"Irina Bancos","orcid":"0000-0001-9332-2524","position":6,"is_corresponding":false},{"id":471421,"name":"Shobana Athimulam","orcid":"0000-0003-1693-3553","position":0,"is_corresponding":true}],"reference_count":37,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-18T22:33:00.770265Z","pmid":"32154561","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}