Researchers reveal scale of prevalence of a condition that can cause typediabetes and high blood pressure

Date:
January 4, 2022
Source:
University of Birmingham
Summary:
Scientists are calling for changes to healthcare policy following
research which has shown for the first time the scale of the impact
of a condition associated with benign tumors that can lead to type
2 diabetes and high blood pressure. Up to 10 per cent of adults
have a benign tumor, or lump, known as an 'adrenal incidentaloma'
in their adrenals -- glands situated on top of the kidneys which
produce a variety of hormones.



FULL STORY ========================================================================== Scientists at the University of Birmingham are calling for changes to healthcare policy following research which has shown for the first time
the scale of the impact of a condition associated with benign tumours
that can lead to type 2 diabetes and high blood pressure.


==========================================================================
Up to 10 per cent of adults have a benign tumour, or lump, known as an
'adrenal incidentaloma' in their adrenals -- glands situated on top
of the kidneys which produce a variety of hormones. The lumps can be
associated with the 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 produce excess cortisol, a condition called Mild Autonomous Cortisol Secretion (MACS).

Now, an international research team led by the University of Birmingham
in the UK has carried out the largest ever prospective study of over
1,305 patients with adrenal incidentalomas to assess their risk of
high blood pressure and type 2 diabetes and their cortisol production, comparing patients with and without MACS. The study is also the first
to undertake a detailed analysis of the steroid hormone production in
patients by analysing cortisol and related hormones by mass spectrometry
in 24-hour urine samples they collected.

Their study findings, published today (January 3rd) in journal Annals of Internal Medicine, show that MACS is much more prevalent than previously reported: with almost every second patient in the study with an adrenal incidentaloma having MACS. Notably, 70% of patients with MACS were women
and most of them were of postmenopausal age (aged over 50). Following
their findings, the researchers now estimate that up to 1.3 million
adults in the UK could have MACS. Considering that around two out of
three of these patients are women, MACS is potentially a key contributor
to women's metabolic health, in particular in women after the menopause.

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."
The study was funded by Diabetes UK, the European Commission, the Medical Research Council, and the Claire Khan Trust Fund at University Hospitals Birmingham Charity.

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 tumours -- 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 research, which took three years
to complete, is part of EURINE-ACT, which is the largest prospective, multi-centre, international study conducted to date on patients with
newly diagnosed adrenal tumours. This first of its kind research effort
was achieved thanks to a collaboration with an international network of
adrenal tumour specialist centres known as the European Network for the
Study of Adrenal Tumours (ENSAT).

========================================================================== Story Source: Materials provided by University_of_Birmingham. Note:
Content may be edited for style and length.


========================================================================== Journal Reference:
1. Alessandro Prete, Anuradhaa Subramanian, Irina Bancos, Vasileios
Chortis,
Stylianos Tsagarakis, Katharina Lang, Magdalena Macech, Danae A.

Delivanis, Ivana D. Pupovac, Giuseppe Reimondo, Ljiljana V. Marina,
Timo Deutschbein, Maria Balomenaki, Michael W. O'Reilly, Lorna
C. Gilligan, Carl Jenkinson, Tomasz Bednarczuk, Catherine D. Zhang,
Tina Dusek, Aristidis Diamantopoulos, Miriam Asia, Agnieszka
Kondracka, Dingfeng Li, Jimmy R. Masjkur, Marcus Quinkler, Grethe
AA. Ueland, M. Conall Dennedy, Felix Beuschlein, Antoine Tabarin,
Martin Fassnacht, Miomira Ivović, Massimo Terzolo, Darko
Kastelan, William F. Young, Konstantinos N.

Manolopoulos, Urszula Ambroziak, Dimitra A. Vassiliadi, Angela
E. Taylor, Alice J. Sitch, Krishnarajah Nirantharakumar, Wiebke
Arlt.

Cardiometabolic Disease Burden and Steroid Excretion in
Benign Adrenal Tumors. Annals of Internal Medicine, 2022; DOI:
10.7326/M21-1737 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2022/01/220104095608.htm
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