Adrenal tumors: Increased mortality with increased cortisol release
adrenal tumors are among the most common tumors in humans, according to experts. It is estimated that up to three percent of all adult “healthy” individuals have a tumor in the adrenal gland, with frequency increasing with age. Researchers have now found that those affected risk of death in case of too much Cortisol is increased.
An international multi-centre study conducted from Würzburg shows that increased cortisol release from benign adrenal tumors is associated with increased mortality, especially in women under the age of 65. The study results were published in the journal “The Lancet Diabetes & Endocrinology” released.
Most adrenal tumors are benign
As in a current Message of the University Hospital Würzburg (UKW), three percent of those over 50 have adrenal tumors. In the over-80s, every tenth person is affected.
However, 80 to 90 percent of these tumors, which are usually discovered by chance, for example during computer tomography in the case of gallbladder problems, kidney stones or back problems, are benign and supposedly harmless.
Supposedly, because a slightly increased production of the hormone cortisol, which many of these tumors entail, divided opinions some time ago. Does the tumor have to be surgically removed or not?
No treatment needed?
Until recently, Prof. Dr. Martin Fassnacht, Head of the Department of Endocrinology and Diabetology at UKW, is of the opinion that most benign adrenal tumors do not need to be treated, only those that lead to severe hormone excess.
In 2014, two studies independently reported that patients with benign adrenal tumors and increased hormone production were more likely to die than those whose tumors did not produce cortisol.
A total of 400 patients were examined. “That wasn’t enough for us, we wanted to know exactly”, so Fasnacht. At that time he addressed the hypothesis that the clinical picture should be ignored in most of those affected and encouraged his European colleagues to conduct a large cohort study called NAPACA Outcome.
According to the information, 28 centers from 16 European countries and two centers from the USA joined. The self-imposed minimum mark of 2,014 study participants was quickly reached and ultimately even doubled.
Of the 4,374 patients admitted, 3,656 met all study criteria: Adults with benign adrenal tumors larger than one centimeter and in whom a dexamethasone test was used to determine whether the tumor produced more cortisol.
Patients with malignant tumors and clinically recognizable hormone excess such as Cushing’s syndrome were excluded. “In the case of Cushing’s syndrome, you can see immediately from the medical examination that you are seriously ill. There is no doubt that there is a need for quick action here.”remarks the scientist.
gender differences
The evaluation of this study also convinced Martin Fassnacht: “Contrary to my hypothesis, those with too much cortisol are actually more likely to die than those without. But it doesn’t affect everyone equally.”explains the researcher.
“To our surprise, we found that women under 65 with high cortisol levels were four times more likely to die than women without high cortisol levels. Interestingly, the latter hardly seems to play a role for men over 65.”
But why is it like that? It could be because of the protection that women generally have up until and ten years after menopause, for example from cardiovascular disease. They are generally healthier than men and also have a longer life expectancy.
“The healthier the patients are, the more relevant the role of cortisol is”, according to Priv.-Doz. dr Timo Deutschbein, research associate at the Chair of Endocrinology and first author of the publication.
“If the young women had a relevantly increased risk profile independent of cortisol, for example diabetes, high blood pressure, obesity and nicotine consumption, cortisol would probably no longer play a significant role.”
Further studies will follow
All of this will now be examined in more detail in follow-up studies. The causal relationship between excess cortisol and higher mortality also needs to be examined.
Finally, mortality could also be related to a previously unknown factor that is responsible for the development and growth of the adrenal tumor and “only incidentally” leads to increased cortisol release.
In the future, it is important to check to whom an operation or drug treatment can be recommended. “Some of the patients would probably benefit from an operation or drug treatment”, Fassnacht revises his initial opinion. (ad)
Author and source information
This text corresponds to the specifications of medical specialist literature, medical guidelines and current studies and has been checked by medical professionals.
Sources:
- University Hospital Würzburg: keep an eye on adrenal tumors, (accessed: 08.05.2022), University Hospital Wuerzburg
- Age-dependent and sex-dependent disparity in mortality in patients with adrenal incidentalomas and autonomous cortisol secretion: an international, retrospective, cohort study; in: The Lancet Diabetes & Endocrinology, (veröffentlicht: 06.05.2022), The Lancet Diabetes & Endocrinology
Important NOTE:
This article contains general advice only and should not be used for self-diagnosis or treatment. He can not substitute a visit at the doctor.