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Up to 10 percent of adults have a benign tumor known as adrenal incidentaloma. It is a lumpin the adrenal glands, which are located on top of the kidneys. These tumors may be associated with the overproduction of hormones, including the steroid stress hormone. cortisol, which can lead to type 2 diabetes and high blood pressure. Small previous studies had suggested that one in three adrenal incidentalomas produces excess cortisol, a condition called Mild Autonomous Cortisol Secretion (MACS).
Now, an international research team led by the University of Birmingham in the United Kingdom has carried out the largest prospective study ever conducted of more than 1,305 patients with adrenal incidentalomas to assess their risk of high blood pressure and type 2 diabetes and their production. cortisol, comparing patients with and without MACS.
The study is also the first to conduct a detailed analysis of steroid hormone production in patients by analyzing cortisol and related hormones using mass spectrometry in 24-hour urine samples.
The findings of their study, published this Monday in the journal “Annals of Internal Medicine,” show that MACS is much more prevalent than previously reported– Nearly one in two study patients with an adrenal incidentaloma has MACS. Specific, 70% of patients with MACS were women and most of them were of postmenopausal age (over 50 years).
The research, which took three years to complete, is part of EURINE-ACT, the largest international prospective multicenter study conducted to date in patients with newly diagnosed adrenal tumors, thanks to the collaboration of the European Network for the Study of Adrenal Tumors. (ENSAT).
Following their findings, the researchers now estimate that up to 1.3 million adults in the UK might have MACS. Considering that around two out of three of these patients are women, MACS is potentially a key factor in women’s metabolic health, particularly in those who have passed the menopause.
‘Compared to those without MACS, we found that patients with MACS were more likely to be diagnosed with high blood pressure and to require three or more tablets to achieve adequate blood pressure control. When we looked at patients with a type 2 diabetes diagnosis, those with MACS were twice as likely to be treated with insulin, indicating that other medications have not helped control their blood sugar levels. In conclusion, our study found that MACS is very common and is a major risk condition for high blood pressure and type 2 diabetes, especially in older women, and the impact of MACS on high blood pressure and type 2 diabetes risk has been underestimated so far‘Explains Dr Alessandro Prete, from the University of Birmingham Metabolism and Systems Research Institute, and first author of the study.
Lead author Professor Wiebke Arlt, Director of the Research Institute for Systems and Metabolism at the University of Birmingham, advocates that ‘all patients who are carriers of an adrenal incidentaloma are screened for and measured for MACS blood pressure and glucose levels regularly. “Now that we have established that MACS is a major risk factor for high blood pressure and type 2 diabetes, our research will focus on three main areas. First, we want to investigate how MACS is related to this increased risk by investigating how excess cortisol affects human metabolism. Second, we are working on a test that can be used in the clinic to identify early which MACS patients are at increased risk of developing high blood pressure and type 2 diabetes. Third, we are testing new treatment strategies to mitigate this risk in affected individuals. Our ultimate goal is to improve the health of the many patients living with MACS, ‘concludes Professor Arlt.
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