Observational Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Mar 15, 2025; 16(3): 100580
Published online Mar 15, 2025. doi: 10.4239/wjd.v16.i3.100580
Continuum of glucose and bone metabolism impairment across autonomous cortisol secretion: A cross-sectional study
Min-Min Han, Xiao-Ming Cao, Zi-Ang Liu, Yi Zhang, Yun-Feng Liu
Min-Min Han, Yun-Feng Liu, Department of Endocrinology, First Hospital of Shanxi Medical University, Taiyuan 030000, Shanxi Province, China
Xiao-Ming Cao, Department of Urology, First Hospital of Shanxi Medical University, Taiyuan 030000, Shanxi Province, China
Zi-Ang Liu, Yi Zhang, Department of Pharmacology, Shanxi Medical University, Taiyuan 030000, Shanxi Province, China
Co-first authors: Min-Min Han and Xiao-Ming Cao.
Co-corresponding authors: Yi Zhang and Yun-Feng Liu.
Author contributions: Han MM and Liu ZA conducted the material preparation, data collection and analyses; Han MM and Cao XM wrote the first draft of the manuscript; All authors commented on previous versions of the manuscript, read and approved the final manuscript, and contributed to the study conception and design. Han MM and Cao XM contributed equally to this study as co-first authors, and Zhang Y and Liu YF contributed equally to this study as co-corresponding authors.
Supported by National Natural Science Foundation of China (General Program), No. 82073909; Four ‘Batches’ Innovation Project of Invigorating Medical through Science and Technology of Shanxi Province, No. 2023XM022; and The Shanxi Provincial Central Leading Local Science and Technology Development Fund Project, No. YDZJSX2022A059 and No. YDZJSX20231A059.
Institutional review board statement: The study was reviewed and approved by the First Hospital of Shanxi Medical University Institutional Review Board (Approval No. 2018K006).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yun-Feng Liu, MD, PhD, Chief Physician, Professor, Department of Endocrinology, First Hospital of Shanxi Medical University, Jiefang South Road, Taiyuan 030000, Shanxi Province, China. nectarliu@163.com
Received: August 21, 2024
Revised: November 26, 2024
Accepted: December 27, 2024
Published online: March 15, 2025
Processing time: 153 Days and 22.6 Hours
Abstract
BACKGROUND

Autonomous cortisol secretion (ACS) is linked to a higher prevalence of metabolic abnormalities and an increased risk of major adverse cardiovascular events.

AIM

To evaluate glucose and bone metabolism in patients with ACS using a continuous glucose monitoring system (CGMS) and dual-energy X-ray absorptiometry (DXA).

METHODS

Patients diagnosed with ACS, including Cushing syndrome, mild ACS (MACS), and nonfunctional adrenal incidentaloma (NFAI), were recruited for this study. Glucose variability and glycemic status were assessed using CGMS. Regional bone mineral content (BMC), bone mineral density (BMD), and bone area (BA) were evaluated using DXA. CGMS- and DXA-derived parameters were compared across the subgroups of ACS. Correlation analysis was performed to examine relationships between varying degrees of cortisol secretion, measured by cortisol after 1 mg overnight dexamethasone suppression test (DST) or 24-hour urine free cortisol (24h UFC), and CGMS- or DXA-derived parameters.

RESULTS

A total of 64 patients with ACS were included in this study: 19 with Cushing syndrome, 11 with MACS, and 34 with NFAI. Glucose variability, time above range (TAR), and time in range (TIR) along with specific areal BMC, BMD, and BA, differed significantly between groups of Cushing syndrome and NFAI. A significant positive correlation was observed between glucose variability or TAR and cortisol after 1 mg overnight DST or 24h UFC. By contrast, TIR, along with regional BMC, BMD, and BA, were negatively correlated with varying degrees of cortisol secretion.

CONCLUSION

Glucose and bone metabolism impairments are on a continuum alteration from NFAI to MACS and Cushing syndrome. Prompt attention should be given to these patients with ACS, especially those with mild hormone secretion. Parameters of glucose variability and glycemic status along with bone condition in regions rich in cancellous bone will provide valuable information.

Keywords: Continuous glucose monitoring system; Glucose variability; Time in range; Autonomous cortisol secretion; Bone mineral content; Bone mineral density; Bone area

Core Tip: Many years elapsed before glucose and bone metabolic disorders in autonomous cortisol secretion (ACS) were studied in clinical and experimental studies. The current study is moving the field forward, highlighting a continuum of glucose and bone metabolism impairment from nonfunctional adrenal incidentaloma to mild ACS and Cushing syndrome. Prompt attention should be given to these patients with ACS, especially those with mild hormone secretion. Given that ACS has a great impact on bone and glucose metabolic disorders with ensuing cardiovascular diseases and fracture, a multidisciplinary effort is needed to choose a patient-tailored treatment and foster the strategies against adverse outcomes.