Evidence mapPaperPMID 40214048Full record

Trial reportThe Journal of clinical endocrinology and metabolism2025

Adrenalectomy Reduces the Risk of Vertebral Fractures in Patients With Mild Autonomous Cortisol Secretion.

Valentina Morelli, Vittoria Favero, Sofia Frigerio, Carmen Aresta, Flavia Pugliese, Antonio Stefano Salcuni, Alessandro Risio, Cristina Eller-Vainicher, Serena Palmieri, Elisa Cairoli and 4 more

Abstract readRandomized Controlled Trial
In one paragraph

Trial report in The Journal of clinical endocrinology and metabolism, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Review
  4. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

Valentina MorelliEndocrinology Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, 20149 Milan, Italy.
Vittoria FaveroDepartment of Medical Biotechnology and Translational Medicine, University of Milan, 20122 Milan, Italy.
Sofia FrigerioUnit of Endocrinology, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy.
Carmen ArestaUnit of Endocrinology, ASST Grande Ospedale Metropolitano Niguarda, 20163 Milan, Italy.
Flavia PuglieseUnit of Endocrinology, "Casa Sollievo della Sofferenza Hospital" IRCCS, 71013 San Giovanni Rotondo, Foggia, Italy.
Antonio Stefano SalcuniUnit of Endocrinology and Metabolism, University-Hospital S. Maria Della Misericordia, 33100 Udine, Italy.
Alessandro RisioDepartment of Medical Biotechnology and Translational Medicine, University of Milan, 20122 Milan, Italy.
Cristina Eller-VainicherUnit of Endocrinology, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy.
Serena PalmieriUnit of Endocrinology, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy.ORCID 0000-0002-1137-461X
Elisa CairoliEndocrinology Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, 20149 Milan, Italy.
Sabrina CorbettaEndocrinology Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, 20149 Milan, Italy.
Giovanna MantovaniUnit of Endocrinology, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy.ORCID 0000-0002-9065-3886
Alfredo ScillitaniUnit of Endocrinology, "Casa Sollievo della Sofferenza Hospital" IRCCS, 71013 San Giovanni Rotondo, Foggia, Italy.
Iacopo ChiodiniEndocrinology Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, 20149 Milan, Italy.ORCID 0000-0001-7594-3300

Funding

Italian Ministry of Health - Ricerca Corrente
6 · The paper itself

Abstract

contextMild autonomous cortisol secretion (MACS) is associated with increased risk of vertebral fractures (VFx).

objectiveThe aim was to investigate impact of recovery from MACS on bone health remains unclear.

methodsRetrospective intervention study (Study 1): 53 patients with MACS were followed for 35.2 ± 18.6 months; 31 patients underwent surgery (Study 1-Group A, 74.2% women, age 63 years [57-67]), while 22 patients received conservative treatment (Study 1-Group B, 45.5% women, age 64 years [61-72]). Prospective randomized study (Study 2): Fifty-one outpatients with MACS were randomly assigned to either adrenalectomy (Study 2-Group A, 21 patients, 67% women, age 63 [56.5-72.5]) or conservative approach (Study 2-Group B, 28 patients, 78% women, age 69 [61-73]) and were followed for 24 months.

methodsMACS was diagnosed in patients with adrenal incidentalomas (AIs) >1 cm and cortisol after the 1-mg dexamethasone suppression test ≥1.8 µg/dL (50 nmol/L). At baseline and at the end of follow-up we assessed calcium-phosphorus metabolism, bone mineral density (BMD) at the lumbar spine (LS), total hip (TH), and femoral neck (FN) using dual-energy X-ray absorptiometry, and the presence of VFx.

resultsStudy 1: At the end of the follow-up, Study 1-Group B showed an increased incidence of VFx (n = 11, 50%) than Study 1-Group A (n = 3, 9.7%, P < .005). In both groups, BMD at LS, FN, and TH was comparable between baseline and the end of follow-up. Study 2: After 24 months in Study 2-Group A, but not in Study 2-Group B, calcium and phosphorus levels increased compared with baseline (P = .03 and P = .04, respectively). At the end of follow-up, BMD remained stable across both groups, but Study 2-Group B showed a significantly higher incidence of VFx (n = 7, 25%) than Study 2-Group A (n = 1, 4.8%, P = .04).

conclusionIn patients with AI and MACS, adrenalectomy significantly reduces the risk of VFx.

Indexed as

AdrenalectomyAdrenal Gland NeoplasmsHydrocortisoneSpinal FracturesAgedBone DensityFemaleFollow-Up StudiesHumansMaleMiddle AgedProspective StudiesRetrospective StudiesRisk FactorsHydrocortisonebone mineral densitymild autonomous cortisol secretionvertebral fracture

Identifiers

PMID40214048
PMCPMC12623015

What Socratic holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.