Abstract: https://www.acpjournals.org/doi/10.7326/M21-1737
Editorial: https://www.acpjournals.org/doi/10.7326/M21-4526
URL goes live when the embargo lifts
A cross-sectional multi-center study of patients with adrenal tumors found that mild autonomous cortisol secretion (MACS) predominantly affects women and is associated with increased frequency and severity of hypertension and type 2 diabetes compared to having nonfunctioning adrenal tumors (NFATs). The study was conducted using the largest ever prospectively recruited group of people with benign adrenal tumors. The findings are published in Annals of Internal Medicine.
Adrenal masses, including NFATs and steroid-overproducing masses, are found during approximately 5 percent of cross-sectional imaging studies and MACS, previously called subclinical Cushing Syndrome, is the most common hormonal abnormality in benign adrenal tumors. MACS has been reported to be associated with type 2 diabetes and hypertension, but little is known about the precise extent of the impact of MACS on cardiometabolic disease risk.
Researchers from the University of Birmingham, Birmingham, United Kingdom, studied data from the European Network for the Study of Adrenal Tumours (ENSAT) to determine cardiometabolic disease burden and steroid excretion in 1,305 persons with benign adrenal tumors with and without MACS. The data showed that many more women than men had MACS and the prevalence of hypertension and diabetes were higher in patients with MACS. Diabetes in these patients more often required insulin therapy to achieve adequate glycemic control. Persons with MACS carried an increased cardiometabolic burden similar to that seen in Cushing Syndrome, even if they did not display typical features of clinically overt cortisol excess. Based on these findings, patients diagnosed with adrenal tumors should have a cardiovascular risk assessment at the time of diagnosis, with particular attention to blood pressure and glucose metabolism.
