Mild autonomous cortisol secretion common in women with benign adrenal tumour

Mild autonomous cortisol secretion (MACS), a cardiometabolic risk condition, mainly affects women with benign adrenal tumour and requires regular assessment for hypertension and type 2 diabetes (T2D), reveals a study.

A team of investigators carried out this cross-sectional study at 14 endocrine secondary and tertiary care centres to determine cardiometabolic disease burden and steroid excretion in individuals with benign adrenal tumours with and without MACS. From 2011 to 2016, they prospectively recruited a total of 1,305 participants.

Cortisol excess was defined by clinical assessment and the 1-mg overnight dexamethasone-suppression test (serum cortisol: <50 nmol/L, nonfunctioning adrenal tumour [NFAT]; 50 to 138 nmol/L, possible MACS [MACS-1]; >138 nmol/L and absence of typical clinical Cushing syndrome features, definitive MACS [MACS-2]). The investigators assessed net steroid production by multisteroid profiling of 24-hour urine using tandem mass spectrometry.

Of the participants, 49.7 percent had NFAT (n=649, 64.1 percent women), 34.6 percent had MACS-1 (n=451, 67.2 percent women), 10.7 percent had MACS-2 (n=140, 73.6 percent women), and 5.0 percent had Cushing syndrome (n=65, 86.2 percent women).

Hypertension was more prevalent and severe in MACS-2 and Cushing syndrome than NFAT (adjusted prevalence ratios [aPRs]: MACS-2, 1.15, 95 percent confidence interval [CI], 1.04‒1.27; Cushing syndrome, 1.37, 95 percent CIC, 1.16‒1.62; aPRs for use of ≥3 antihypertensives: MACS-2, 1.31, 95 percent CI, 1.02‒1.68; Cushing syndrome, 2.22, 95 percent CI, 1.62‒3.05).

Prevalence of T2D was higher in CS than NFAT (aPR, 1.62, 95 percent CI, 1.08‒2.42), while the use of insulin therapy was more likely for MACS-2 (aPR, 1.89, 95 percent CI, 1.01‒3.52) and Cushing syndrome (aPR, 3.06, 95 percent CI, 1.60‒5.85).

In urinary multisteroid profiling, an increase was noted in glucocorticoid excretion from NFAT over MACS-2 and MACS-2 to Cushing syndrome; on the other hand, androgen excretion decreased.

The study was limited by its cross-sectional design and potential selection bias.