TY - JOUR
T1 - Cardiometabolic Disease Burden and Steroid Excretion in Benign Adrenal Tumors A Cross-Sectional Multicenter Study
AU - Prete, Alessandro
AU - Subramanian, Anuradhaa
AU - Bancos, Irina
AU - Chortis, Vasileios
AU - Tsagarakis, Stylianos
AU - Lang, Katharina
AU - Macech, Magdalena
AU - Delivanis, Danae A.
AU - Pupovac, Ivana D.
AU - Reimondo, Giuseppe
AU - Marina, Ljiljana V.
AU - Deutschbein, Timo
AU - Balomenaki, Maria
AU - O’Reilly, Michael W.
AU - Gilligan, Lorna C.
AU - Jenkinson, Carl
AU - Bednarczuk, Tomasz
AU - Zhang, Catherine D.
AU - Dusek, Tina
AU - Diamantopoulos, Aristidis
AU - Asia, Miriam
AU - Kondracka, Agnieszka
AU - Li, Dingfeng
AU - Masjkur, Jimmy R.
AU - Quinkler, Marcus
AU - Ueland, Grethe
AU - Dennedy, M. Conall
AU - Beuschlein, Felix
AU - Tabarin, Antoine
AU - Fassnacht, Martin
AU - Ivovic, Miomira
AU - Terzolo, Massimo
AU - Kastelan, Darko
AU - Young, William F.
AU - Manolopoulos, Konstantinos N.
AU - Ambroziak, Urszula
AU - Vassiliadi, Dimitra A.
AU - Taylor, Angela E.
AU - Sitch, Alice J.
AU - Nirantharakumar, Krishnarajah
AU - Arlt, Wiebke
AU - Glöckner, Stephan
AU - Sinnott, Richard O.
AU - Stell, Anthony
AU - Fragoso, Maria Candida B.V.
AU - Simunov, Bojana
AU - Cazenave, Sarah
AU - Haissaguerre, Magalie
AU - Bertherat, Jérôme
AU - Haak, Harm R.
AU - ENSAT EURINE-ACT Investigators
N1 - Funding Information:
Prete]), by the European Commission under the 7th Framework Programme (FP7/2007-2013, grant agreement 259735, ENSAT-CANCER [Drs. Arlt, Fassnacht, and Beuschlein]), and under the European Union's Horizon 2020 Research and Innovation Program under grant agreement no. 633983 (ENSAT–HT) (Drs. Arlt and Beuschlein). This work was also supported by the U.K. Medical Research Council (strategic biomarker grant G0801473 [Dr. Arlt]), the Claire Khan Trust Fund at University Hospitals Birmingham Charities (project grant [Dr. Arlt]), the Mayo Clinic Foundation for Medical Education and Research (Mayo scholarship [Dr. Bancos]), the Wellcome Trust (clinical research training fellowship WT101671 [Dr. Chortis] and investigator award WT209492/Z/17/Z [Dr. Arlt]), and the Academy of Medical Sciences (starter grant for clinical lecturers [Dr. Chortis]). This research was partly supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the U.S. National Institutes of Health under award K23DK121888 (Dr. Bancos). Drs. Arlt and Sitch receive support from the NIHR Birmingham Biomedical Research Centre at the University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham (grant reference number BRC-1215-20009). Dr. Beuschlein receives funding from the Clinical Research Priority Program of the University of Zurich for CRPP HYRENE (Clinical Research Priority Program HYpertension REsearch NEtwork). Support for this study also came in part from the Deutsche Forschungsgemeinschaft (project number 314061271; CRC/ Transregio 205) (Drs. Fassnacht and Beuschlein).
Funding Information:
Grant Support: This work was supported by Diabetes UK (Sir George Alberti Research Training Fellowship 18/0005782 [Dr.
Funding Information:
Primary Funding Source: Diabetes UK, the European Commission, U.K. Medical Research Council, the U.K. Academy of Medical Sciences, the Wellcome Trust, the U.K. National Institute for Health Research, the U.S. National Institutes of Health, the Claire Khan Trust Fund at University Hospitals Birmingham Charities, and the Mayo Clinic Foundation for Medical Education and Research.
Publisher Copyright:
© 2022 American College of Physicians. All rights reserved.
PY - 2022/3/1
Y1 - 2022/3/1
N2 - Background: Benign adrenal tumors are commonly discovered on cross-sectional imaging. Mild autonomous cortisol secretion (MACS) is regularly diagnosed, but its effect on cardiometabolic disease in affected persons is ill defined. Objective: To determine cardiometabolic disease burden and steroid excretion in persons with benign adrenal tumors with and without MACS. Design: Cross-sectional study. Setting: 14 endocrine secondary and tertiary care centers (recruitment from 2011 to 2016). Participants: 1305 prospectively recruited persons with benign adrenal tumors. Measurements: Cortisol excess was defined by clinical assessment and the 1-mg overnight dexamethasone-suppression test (serum cortisol: <50 nmol/L, nonfunctioning adrenal tumor [NFAT]; 50 to 138 nmol/L, possible MACS [MACS-1]; >138 nmol/L and absence of typical clinical Cushing syndrome [CS] features, definitive MACS [MACS-2]). Net steroid production was assessed by multisteroid profiling of 24-hour urine by tandem mass spectrometry. Results: Of the 1305 participants, 49.7% had NFAT (n = 649; 64.1% women), 34.6% had MACS-1 (n = 451; 67.2% women), 10.7% had MACS-2 (n = 140; 73.6% women), and 5.0% had CS (n = 65; 86.2% women). Prevalence and severity of hypertension were higher in MACS-2 and CS than NFAT (adjusted prevalence ratios [aPRs] for hypertension: MACS-2, 1.15 [95% CI, 1.04 to 1.27], and CS, 1.37 [CI, 1.16 to 1.62]; aPRs for use of =3 antihypertensives: MACS-2, 1.31 [CI, 1.02 to 1.68], and CS, 2.22 [CI, 1.62 to 3.05]). Type 2 diabetes was more prevalent in CS than NFAT (aPR, 1.62 [CI, 1.08 to 2.42]) and more likely to require insulin therapy for MACS-2 (aPR, 1.89 [CI, 1.01 to 3.52]) and CS (aPR, 3.06 [CI, 1.60 to 5.85]). Urinary multisteroid profiling revealed an increase in glucocorticoid excretion from NFAT over MACS-1 and MACS-2 to CS, whereas androgen excretion decreased. Limitations: Cross-sectional design; possible selection bias. Conclusion: A cardiometabolic risk condition, MACS predominantly affects women and warrants regular assessment for hypertension and type 2 diabetes.
AB - Background: Benign adrenal tumors are commonly discovered on cross-sectional imaging. Mild autonomous cortisol secretion (MACS) is regularly diagnosed, but its effect on cardiometabolic disease in affected persons is ill defined. Objective: To determine cardiometabolic disease burden and steroid excretion in persons with benign adrenal tumors with and without MACS. Design: Cross-sectional study. Setting: 14 endocrine secondary and tertiary care centers (recruitment from 2011 to 2016). Participants: 1305 prospectively recruited persons with benign adrenal tumors. Measurements: Cortisol excess was defined by clinical assessment and the 1-mg overnight dexamethasone-suppression test (serum cortisol: <50 nmol/L, nonfunctioning adrenal tumor [NFAT]; 50 to 138 nmol/L, possible MACS [MACS-1]; >138 nmol/L and absence of typical clinical Cushing syndrome [CS] features, definitive MACS [MACS-2]). Net steroid production was assessed by multisteroid profiling of 24-hour urine by tandem mass spectrometry. Results: Of the 1305 participants, 49.7% had NFAT (n = 649; 64.1% women), 34.6% had MACS-1 (n = 451; 67.2% women), 10.7% had MACS-2 (n = 140; 73.6% women), and 5.0% had CS (n = 65; 86.2% women). Prevalence and severity of hypertension were higher in MACS-2 and CS than NFAT (adjusted prevalence ratios [aPRs] for hypertension: MACS-2, 1.15 [95% CI, 1.04 to 1.27], and CS, 1.37 [CI, 1.16 to 1.62]; aPRs for use of =3 antihypertensives: MACS-2, 1.31 [CI, 1.02 to 1.68], and CS, 2.22 [CI, 1.62 to 3.05]). Type 2 diabetes was more prevalent in CS than NFAT (aPR, 1.62 [CI, 1.08 to 2.42]) and more likely to require insulin therapy for MACS-2 (aPR, 1.89 [CI, 1.01 to 3.52]) and CS (aPR, 3.06 [CI, 1.60 to 5.85]). Urinary multisteroid profiling revealed an increase in glucocorticoid excretion from NFAT over MACS-1 and MACS-2 to CS, whereas androgen excretion decreased. Limitations: Cross-sectional design; possible selection bias. Conclusion: A cardiometabolic risk condition, MACS predominantly affects women and warrants regular assessment for hypertension and type 2 diabetes.
U2 - 10.7326/M21-1737
DO - 10.7326/M21-1737
M3 - Article
C2 - 34978855
SN - 0003-4819
VL - 175
SP - 325
EP - 334
JO - Annals of Internal Medicine
JF - Annals of Internal Medicine
IS - 3
ER -