A new study by researchers at the University of Birmingham has shown for the first time a condition could double risk of type 2 diabetes and high blood pressure in women.

Patients with adrenal tumors who have mild autonomous cortisol secretion (MACS) have higher rates of hypertension and type 2 diabetes than those who have nonfunctioning adrenal tumors (NFATs), according to a cross-sectional multi-center study.

MACS is more common in women and is associated with higher rates of both hypertension and type 2 diabetes.

The study included the biggest prospectively recruited sample of adults with benign adrenal tumors ever.

MACS, previously known as subclinical Cushing Syndrome, is the most frequent hormonal anomaly in benign adrenal tumors. Adrenal masses, including NFATs and steroid-overproducing masses, are identified in about 5% of cross-sectional imaging examinations.

MACS has been found to be related with type 2 diabetes and hypertension, although little is known regarding the specific amount to which MACS increases the risk of developing cardiometabolic disease.

Using data from the European Network for the Study of Adrenal Tumors (ENSAT), researchers from the University of Birmingham in the United Kingdom, examined 1,305 patients with benign adrenal tumors and MACS to determine the burden of cardiometabolic disease and steroid excretion.

The data revealed that women were significantly more likely than men to be diagnosed with MACS, and that the frequency of hypertension and diabetes was higher in patients with MACS. These patients’ diabetes frequently required insulin therapy to maintain acceptable glycemic control.

In spite of the absence of typical signs of clinically overt cortisol excess, individuals with MACS have an increased cardiometabolic load comparable to that reported in Cushing Syndrome.

A cardiovascular risk assessment should be performed at the time of diagnosis for individuals with adrenal tumors, with special emphasis paid to blood pressure and glucose metabolism.

The first author of the study 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.”

Source: 10.7326/M21-1737

Image Credit: Getty

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