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Adrenal tumour 'underestimated' as risk factor

Wednesday January 5th 2022

Researchers have shown how a cardiometabolic condition present in benign adrenal tumours can lead to type 2 diabetes.

Mild autonomous cortisol secretion, or MACS, can develop when a benign tumour on the adrenal glands causes the overproduction of the steroid hormone cortisol. About a third of people with these 'adrenal incidentalomas' develop MACS.

Its prevalence was measured by scientists at the University of Birmingham, UK. Writing in *Annals of Internal Medicine* yesterday, they state: "MACS is regularly diagnosed, but its effect on cardiometabolic disease in affected persons is ill defined."

They recruited 1,305 participants with benign adrenal tumours from 14 endocrine centres between 2011 and 2016.

Cortisol tests showed that 50% had non-functioning adrenal tumour, 35% had possible MACS, 10% had definitive MACS, and 5% had Cushing syndrome.

Hypertension was more likely in those with definitive MACS and Cushing syndrome, and type 2 diabetes was more likely with Cushing syndrome.

The authors conclude: "A cardiometabolic risk condition, MACS predominantly affects women and warrants regular assessment for hypertension and type 2 diabetes."

First author Dr Alessandro Prete said: “Compared to those without MACS, we observed that patients with MACS were more likely to be diagnosed with high blood pressure and to require three or more tablets to achieve an adequate blood pressure control.

"When we looked at patients with a diagnosis of type 2 diabetes, those with MACS were twice more likely to be treated with insulin, indicating that other medications haven’t helped managing their blood sugar levels.

"In conclusion, our study found that MACS is very frequent and is an important 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 until now.”

Prete, A. et al. Cardiometabolic disease burden and steroid excretion in benign adrenal tumors: a cross-sectional multi-centre study. *Annals of Internal Medicine* 4 January 2022; doi: 10.7326/M21-1737

[abstract]

Tags: Diabetes | Heart Health | UK News | Women's Health & Gynaecology

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