Following research that revealed for the first time the size of the impact of a condition connected with benign tumors that can lead to type 2 diabetes and high blood pressure, scientists from the University of Birmingham are asking for changes in healthcare policy.
Up to 10% of adults have an ‘adrenal incidentaloma,’ a benign tumor or lump in their adrenal glands, which are located on top of the kidneys and generate several hormones.
Overproduction of hormones, especially the stress steroid hormone cortisol, has been linked to lumps, which can lead to type 2 diabetes and high blood pressure. According to previous modest research, one of every three adrenal incidentalomas produces too much cortisol, a condition known as Mild Autonomous Cortisol Secretion (MACS).
Now, an international research team led by the University of Birmingham in the United Kingdom has conducted the largest-ever prospective study of 1,305 patients with adrenal incidentalomas to assess their risk of high blood pressure, type 2 diabetes, and cortisol production, comparing patients with and without MACS.
The study is also the first to examine steroid hormone synthesis in patients in depth, using mass spectrometry to analyze cortisol and related hormones in 24-hour urine samples obtained.
Their findings, which were published today (January 3rd) in the journal Annals of Internal Medicine, demonstrate that MACS is far more common than previously thought, with MACS occurring in nearly every second patient with an adrenal incidentaloma in the research. Notably, 70% of MACS patients were women, with the majority of them being postmenopausal (aged over 50).
This important research, funded by Diabetes UK, reveals that a condition associated with benign adrenal tumors Mild Autonomous Cortisol Secretion (MACS) is more common and may have more of a negative impact on health, including increasing the risk of type 2 diabetes, than previously thought. These findings suggest that screening for MACS could help to identify people, particularly women, in whom the condition was found to be more common who may benefit from support to reduce their risk of type 2 diabetes.
Dr. Lucy Chambers
The researchers now believe that up to 1.3 million persons in the UK may have MACS as a result of their findings. MACS could be an important contributor to women’s metabolic health, especially in women after menopause, given that two out of every three of these patients are women.
First author Dr. Alessandro Prete, of the University of Birmingham’s Institute of Metabolism and Systems Research, 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.”
Senior author Professor Wiebke Arlt, Director of the University of Birmingham’s Institute of Metabolism and Systems Research, said:
“Previous studies suggested that MACS is associated with poor health. However, our study is the largest ever study to establish conclusively the extent of the risk and severity of high blood pressure and type 2 diabetes in patients with MACS. Our hope is that this research will put a spotlight on this condition and increase awareness of its impact on health. We advocate that all patients who are found to carry an adrenal incidentaloma are tested for MACS and have their blood pressure and glucose levels measured regularly.”
Diabetes UK, the European Commission, the Medical Research Council, and the Claire Khan Trust Fund at University Hospitals Birmingham Charity all contributed to the research.
Dr. Lucy Chambers, Head of Research Communications at Diabetes UK, said:
“This important research, funded by Diabetes UK, reveals that a condition associated with benign adrenal tumors Mild Autonomous Cortisol Secretion (MACS) is more common and may have more of a negative impact on health, including increasing the risk of type 2 diabetes, than previously thought. These findings suggest that screening for MACS could help to identify people, particularly women, in whom the condition was found to be more common who may benefit from support to reduce their risk of type 2 diabetes.”
“We look forward to further research to uncover how MACS is linked to increased risk of type 2 diabetes, which could in the future lead to new ways of treating and preventing type 2 diabetes in those with MACS. If you have MACS and are concerned about your risk of type 2 diabetes, it’s important to speak to your GP or endocrinologist.”
Professor Arlt added: “Now that we have established that MACS is an important risk factor for high blood pressure and type 2 diabetes, our research will focus on three main areas. First, we want to look into how MACS is linked to this increased risk by investigating how cortisol excess affects human metabolism.”
“Second, we are working on a test that can be used in the clinic to identify early on which patients with MACS carry a higher 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 aim is to improve the health of the many patients living with MACS.”
The study, which took three years to complete, is part of EURINE-ACT, the biggest prospective, multi-center, multinational study on patients with newly diagnosed adrenal tumors to date.
This groundbreaking research was made possible thanks to a collaboration with the European Network for the Study of Adrenal Tumours (ENSAT), an international network of adrenal tumors specialist centers.
