Unveiling the hidden impact: Subclinical hypercortisolism and its subtle influence on bone health

Abstract In recent years, advancements in imaging technologies have led to an increased detection rate of adrenal incidentalomas (AI), with age demonstrating a significant correlation with their incidence. Among the various forms of functional adrenal incidentalomas, subclinical hypercortisolism (SH) stands out as a predominant subtype. Despite the absence of typical symptoms associated with Cushing's syndrome, both domestic and international research consistently establishes a robust link between SH and diverse metabolic irregularities, including hypertension, lipid metabolism disorders, glucose metabolism abnormalities, and disruptions in bone metabolism. Individuals with SH face an elevated risk of cardiovascular events and mortality, highlighting the clinical significance of addressing this condition. Prolonged exposure to elevated cortisol levels poses a significant threat to bone health, contributing to bone loss, alterations in bone microstructure, and an increased susceptibility to fractures. However, comprehensive reviews addressing bone metabolism changes and associated mechanisms in SH patients are currently lacking. Furthermore, the profound impact of concurrent SH on the overall health of the elderly cannot be overstated. A comprehensive understanding of the skeletal health status in elderly individuals with concomitant SH is imperative. This article aims to fill this gap by offering a detailed review of bone metabolism changes and associated mechanisms in SH patients arising from AI. Additionally, it provides a forward‐looking perspective on research concerning skeletal health in elderly individuals with concurrent SH.

摘要 近年来，成像技术的进步导致肾上腺意外瘤（AI）的检出率提高，年龄与其发病率呈现显著相关性。在各种类型的功能性肾上腺意外瘤中，亚临床皮质醇增多症（SH）是主要的亚型。尽管没有库欣综合征相关的典型症状，但国内外研究一致表明SH与多种代谢异常之间存在紧密联系，包括高血压、脂质代谢紊乱、糖代谢异常以及骨代谢紊乱。患有SH的个体面临心血管事件和死亡的风险升高，这凸显了处理该病症的临床重要性。长期暴露于升高的皮质醇水平对骨骼健康构成重大威胁，会导致骨质流失、骨微结构改变以及骨折易感性增加。然而，目前缺乏针对SH患者骨代谢变化及相关机制的综合综述。此外，并发的SH对老年人整体健康的深远影响不可低估。全面了解伴有SH的老年人的骨骼健康状况至关重要。本文旨在通过详细综述由AI引发的SH患者的骨代谢变化及相关机制来填补这一空白。此外，本文还对伴有并发SH的老年人骨骼健康的研究提供了前瞻性观点。