TY - JOUR
T1 - Cardiometabolic disease burden and steroid excretion in benign adrenal tumors
T2 - 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
AU - Pupovac, Ivana
AU - Reimondo, Giuseppe
AU - Marina, Ljiljana
AU - Deutschbein, Timo
AU - Balomenaki, Maria
AU - O'reilly, Michael
AU - Gilligan, Lorna
AU - Jenkinson, Carl
AU - Bednarczuk, Tomasz
AU - Zhang, Catherine
AU - Dusek, Tina
AU - Diamantopoulos, Aristidis
AU - Asia, Miriam
AU - Kondracka, Agnieszka
AU - Li, Dingfeng
AU - Masjkur, Jimmy
AU - Quinkler, Marcus
AU - Ueland, Grethe
AU - Dennedy, Conall
AU - Beuschlein, Felix
AU - Tabarin, Antoine
AU - Fassnacht, Martin
AU - Ivovic, Miomira
AU - Terzolo, Massimo
AU - Kastelan, Darko
AU - Young Jr, William
AU - Manolopoulos, Konstantinos
AU - Ambroziak, Urszula
AU - Vassiliadi, Dimitra
AU - Taylor, Angela
AU - Sitch, Alice
AU - Nirantharakumar, Krishnarajah
AU - Arlt, Wiebke
PY - 2022/3
Y1 - 2022/3
N2 - 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.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.
AB - 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.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.
UR - http://www.scopus.com/inward/record.url?scp=85126490824&partnerID=8YFLogxK
U2 - 10.7326/M21-1737
DO - 10.7326/M21-1737
M3 - Article
SN - 0003-4819
VL - 175
SP - 325
EP - 334
JO - Annals of internal medicine
JF - Annals of internal medicine
IS - 3
ER -