期刊
ANNALS OF INTERNAL MEDICINE
卷 175, 期 3, 页码 325-+出版社
AMER COLL PHYSICIANS
DOI: 10.7326/M21-1737
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资金
- Diabetes UK (Sir George Alberti Research Training Fellowship) [18/0005782]
- European Commission [259735]
- European Union [633983]
- U.K. Medical Research Council [G0801473]
- Claire Khan Trust Fund at University Hospitals Birmingham Charities
- Mayo Clinic Foundation for Medical Education and Research
- Wellcome Trust [WT101671, WT209492/Z/17/Z]
- Academy of Medical Sciences
- National Institute of Diabetes and Digestive and Kidney Diseases of the U.S. National Institutes of Health [K23DK121888]
- NIHR Birmingham Biomedical Research Centre at the University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham [BRC-1215-20009]
- Clinical Research Priority Program of the University of Zurich
- Deutsche Forschungsgemeinschaft [314061271, CRC/Transregio 205]
- MRC [MR/R002339/1, G0801473] Funding Source: UKRI
Patients with mild autonomous cortisol secretion (MACS), especially MACS-2 and CS, have a higher prevalence and severity of hypertension and type 2 diabetes. MACS predominantly affects women and regular assessment for cardiometabolic diseases is warranted.
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.
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