New research suggests that patients with adrenal tumors that secrete a hormone called cortisol are at higher risk of suffering cardiovascular events and increased mortality. Investigators say their findings may lead to better clinical management of patients with these tumors.
This is according to a new study published in The Lancet Diabetes & Endocrinology.
Adrenal tumors (adrenal incidentalomas) can often produce a sex hormone called cortisol. High secretion of cortisol can lead to Cushing's syndrome (overt hypercortisolism).
Symptoms include weight gain, thinning skin that is easily bruised, appearance of stretch marks and decreased interest in sex.
Because these symptoms are fairly general, they can be hard to spot. Therefore, adrenal tumors are often referred to as "silent" tumors.
Many of these tumors are found by accident as patients undergo computed tomography (CT) scans. According to the research team, led by Prof. Renato Pasquali of the S Orsola-Malpighi Hospital in Bologna, Italy, approximately 4% of CT scans coincidentally uncover an adrenal tumor.
The researchers say their findings may help clinicians to better manage patients with adrenal tumors.
But the investigators say there is limited evidence detailing how these tumors progress, meaning clinicians are unclear how to manage them once they are discovered.
With the aim of uncovering how adrenal tumors advance, the research team analyzed 198 patients with adrenal incidentalomas who were referred to the endocrinology unit of the S Orsola-Malpighi Hospital between 1995 and 2010.
All patients were assessed every 18-30 months for the first 5 years, and the mean follow-up period was 7.5 years.
At each assessment, the researchers determined whether the patients' adrenal tumors were secreting cortisol and at what measures, using a dexamethasone suppression test (DST).
At the end of the follow-up period, researchers found that 114 patients had stable non-secreting adrenal tumors, 61 patients had either subclinical Cushing's syndrome or a stable intermediate phenotype tumor, while 23 had adrenal tumors that had worsened in its secretion levels.
Increased risk of cardiovascular events and shorter survival
The investigators found that, compared with patients who had non-secreting adrenal tumors, individuals with either subclinical Cushing's syndrome or a stable intermediate phenotype tumor, or those whose tumors had worsened in secreting patterns, were at a significantly higher risk of experiencing cardiovascular events.
Furthermore, the research team found that these individuals also had lower survival rates for all-cause mortality.
Commenting on the results of the study, the researchers say:
"Our findings are important because they add to the previously scant information about adrenal incidentalomas, which will be of use to doctors who are seeing an increasing number of patients with these masses.
We have shown that subclinical hypercortisolism (Cushing's syndrome) can be deleterious in individuals with adrenal masses, and this condition can develop even in people with non-secreting adrenal adenomas at baseline."
Based on their findings, the researchers suggest that patients with adrenal tumors should undergo periodic DST tests to determine whether they are heading toward cortisol overproduction.
They note that for patients with mild hypercortisolism, surgery may be the best option, particularly if they are at higher risk of experiencing cardiovascular events.
"However," they conclude, "medical treatment for bilateral forms of hypercortisolism should be investigated by specific follow-up studies designed for this reason."
In a comment piece linked to the study, Prof. Rosario Pivonello, of the Università Federico II in Naples, Italy, says the study findings support the importance of long-term clinical hormonal monitoring for patients with adrenal tumors.
"Furthermore," Prof. Pivonello adds, "clinical monitoring of cardiometabolic risks seems to be important in these patients, particularly in those with subclinical Cushing's syndrome and intermediate phenotype adrenal incidentalomas, for whom medical or surgical intervention could be needed."