University of Birmingham scientists are calling for a change in health policy after research for the first time showed the magnitude of the effects of a disease associated with benign tumors that can lead to type 2 diabetes and high blood pressure.
Up to 10 percent of adults have a benign tumor or lump known as “adrenal incidence” in their adrenal glands – glands located on top of the kidneys that produce a variety of hormones. The lumps can be linked to overproduction of hormones, including the stress steroid hormone cortisol, which can lead to type 2 diabetes and high blood pressure. Previous small studies suggested that one in three adrenal incidentalomas produces excess cortisol, a condition known as mild autonomic cortisol secretion (MACS).
Now, an international research team led by the University of Birmingham in the UK has carried out the largest prospective study of over 1,305 patients with adrenal incidence to assess their risk for high blood pressure and type 2 diabetes, as well as their cortisol production, and patients with and without MACS. The study is also the first to perform a detailed analysis of steroid hormone production in patients by analyzing cortisol and related hormones by mass spectrometry in 24-hour urine samples collected from them.
Their study results, published today (January 3rd) in the journal Annals of Internal Medicine, show that MACS is much more common than previously reported: Almost every second patient in the study with an adrenal incidence has MACS. Notably, 70% of patients with MACS were women and most of them were postmenopausal (over 50 years of age). According to their results, the researchers now estimate that up to 1.3 million adults in the UK could have MACS. Given that around two out of three of these patients are women, MACS may be a significant contributor to metabolic health in women, especially in postmenopausal women.
The first author Dr. Alessandro Prete of the University of Birmingham’s Institute of Metabolism and Systems Research said: “Compared to those without MACS, we have observed that patients with MACS are more likely to be diagnosed with high blood pressure and require three or more tablets to achieve adequate blood pressure control. When we looked at patients diagnosed with type 2 diabetes, patients with MACS were twice as likely to be treated with insulin, suggesting that other drugs did not help control their blood sugar levels. In conclusion, our study found that MACS is very common and a major risk disease for high blood pressure and type 2 diabetes, especially in older women, and the effects of MACS on high blood pressure and the risk of type 2 diabetes have been underestimated. “
Senior author Professor Wiebke Arlt, Director of the Institute of Metabolism and Systems Research at the University of Birmingham, said: “Previous studies indicated that MACS was linked to poor health. However, our study is the largest study to date that has conclusively determined the extent of the risk and severity of high blood pressure and type 2 diabetes in patients with MACS. We hope that this research will highlight this disease and raise awareness of its health effects. We advocate that all patients found to have an adrenal incidence be tested for MACS and that their blood pressure and glucose levels be measured regularly. “
The study was funded by Diabetes UK, the European Commission, the Medical Research Council and the Claire Khan Trust Fund of the University Hospitals Birmingham Charity.
Dr. Lucy Chambers, Head of Research Communications at Diabetes UK said: “This important study, funded by Diabetes UK, shows that a condition associated with benign adrenal gland tumors – Mild Autonomous Cortisol Secretion (MACS) – is more common and can have more negative health effects, including an increased risk of type 2 diabetes, than previously thought. These results suggest that screening for MACS could help identify people – especially women who are more likely to have the condition – who could benefit from assistance in reducing their risk of type 2 diabetes. We look forward to further research to find out how MACS is linked to an increased risk of type 2 diabetes, which could lead to new ways of treating and preventing type 2 diabetes in patients with MACS in the future. If you have MACS and are concerned about your risk of type 2 diabetes, it is important to speak to your GP or endocrinologist. “
Professor Arlt added: “After discovering that MACS is a major risk factor for high blood pressure and type 2 diabetes, we focus our research on three main areas. First, we would like to examine how MACS is linked to this increased risk by examining how excess cortisol affects human metabolism. Second, we are working on a test that can be used in the clinic to identify at an early stage which patients with MACS are at increased risk of high blood pressure and type 2 diabetes. Third, we are testing new treatment strategies to reduce this risk in affected individuals. Our ultimate goal is to improve the health of the many patients with MACS. “
The three-year research is part of EURINE-ACT, the largest prospective, multicenter, international study that has been carried out to date on patients with newly diagnosed adrenal tumors. This first research effort of its kind was achieved thanks to a collaboration with an international network of specialized centers for adrenal tumors, the European Network for the Study of Adrenal Tumors (ENSAT).
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Notes for editors
- Prete A et al. (December 2021). “Exposure to Cardiometabolic Disorders and Steroid Excretion in Benign Adrenal Tumors: A Multi-Center Cross-Sectional Study”. Internal Medicine Annals. DOI [insert here]
- The University of Birmingham is ranked in the top 100 institutions in the world and its work brings people to Birmingham from all over the world, including researchers and teachers, as well as more than 6,500 international students from nearly 150 countries.
Internal Medicine Annals
Exposure to cardiometabolic disease and steroid excretion in benign adrenal tumors: a multicenter cross-sectional study
Publication date of the article
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