‘Benign’ Adrenal Gland Tumors Might Cause Harm to Millions

By Dennis Thompson, HealthDay reporter >

Wednesday, January 5, 2022 – Millions of people are at an increased risk of developing type 2 diabetes and high blood pressure and don’t even know it, due to a hidden hormonal problem in their bodies.

As many as 1 in 10 people have a noncancerous tumor in one or both adrenal glands, which can cause the gland to overproduce the stress hormone cortisol.

Until now, doctors believed that these tumors had little effect on your health.

But a new study from Britain found that up to half of people with these adrenal tumors secrete enough excess cortisol to increase the risk of diabetes and high blood pressure.

The researchers said nearly 1.3 million adults in the UK alone could suffer from this disorder, which is called mild independent cortisol secretion (MACS).

Anyone found to have one of these adrenal tumors should be screened to see if their health is at risk, said lead researcher Dr Webeck Arlt, director of the Institute of Metabolism and Systems Research at the University of Birmingham in England.

“People who are found to have an adrenal tumor should have an evaluation for hypercortisolism, and if they are found to have hypercortisol production, they should be screened regularly for type 2 diabetes and high blood pressure and receive treatment if appropriate,” Arlt said.

These tumors are usually discovered during abdominal radiographs to treat other diseases, said Dr. André Lacroix, an endocrinologist at the University Hospital Center of Montreal, who wrote an editorial accompanying the study. Both were published on January 4th in Annals of internal medicine.

The adrenal glands primarily produce the hormone adrenaline, Lacroix said, but they are also responsible for producing a number of other hormones, including cortisol.

Dubbed the “fight or flight” hormone, cortisol can cause blood sugar levels to rise and blood pressure to rise — usually in response to some perceived physical threat.

Previous studies have indicated that about 1 in 3 adrenal gland tumors secrete excess cortisol, and even fewer have led to cortisol levels so high that they affect health, researchers said in Background Notes.

But this new study of more than 1,300 people with adrenal tumors found that previous estimates were wrong.

About half of these patients have excess cortisol due to adrenal adenomas. Furthermore, more than 15% had levels high enough to affect their health, compared to those with truly benign tumors.

MACS patients were twice as likely to develop hypertension, and were twice as likely to have been exposed to three or more blood pressure medications.

The study found that they were more likely to develop type 2 diabetes, and were twice as likely to need insulin to control their blood sugar.

“This study clearly shows that mild cortisol production is more frequent than we previously thought, and that the more cortisol you produce, the more likely you are to experience consequences such as diabetes and high blood pressure,” Lacroix said.

About 70% of people with MACS were women, the researchers said, and most were postmenopausal.

“The hypercortisolism associated with adrenal adenomas is an important, previously overlooked health problem that particularly affects postmenopausal women,” Arlt said.

Lacroix agreed that guidelines should be changed so that people with adrenal tumors are screened regularly.

“Everyone who is found to have an adrenal nodule larger than one centimeter needs to be tested to see if they are producing excess hormone or not,” he said. “This is very clear.”

A number of medications can reduce the overproduction of cortisol or block the action of cortisol, if an adrenal tumor is found to be causing an excess of the hormone.

Lacroix said that people with severe hypercortisolism can even have one of their adrenal glands removed if necessary.

“It is very possible to live normally with one adrenal gland,” he said.

Resources

  • Wiebke Arlt, MD, DSc, Director, Institute of Metabolism and Systems Research, University of Birmingham, UK
  • Andr & Ecute
  • Lacroix, MD, endocrinologist, University Hospital Center Montreal
  • Annals of internal medicineJanuary 4, 2022

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