Adrenal tumors: increased mortality with increased release of cortisol
adrenal tumors are among the most common cancers in humans, according to experts. It is estimated that up to three percent of all “healthy” adults have a tumor in the adrenal gland, which increases with age. Researchers have now found that those affected risk of death in case of too much cortisol increased.
An international multicenter study conducted by Würzburg shows that increased cortisol release from benign adrenal tumors is associated with increased mortality, especially in women under the age of 65. The results of the study were published in The Lancet Diabetes & Endocrinology.
Most adrenal tumors are benign
As explained in a recent report from the University Hospital of Würzburg (UKW), three per cent of people over the age of 50 have adrenal tumors. In the 1980s, one in ten people are affected.
However, 80 to 90 percent of these cancers, which are usually discovered by accident, such as during a computed tomography in the case of gallbladder problems, kidney stones or back problems, are benign and presumably harmless.
Presumably, because a slightly increased production of the hormone cortisol, which leads to many of these cancers, divided opinions some time ago. Does the tumor need to be surgically removed or not?
No treatment needed?
Until recently, Prof. Dr. Martin Fassnacht, head of the UKW’s Department of Endocrinology and Diabetology, is of the opinion that most benign adrenal tumors should not be treated, but only those that lead to severe excess of hormones.
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. “It wasn’t enough, we wanted to know exactly”, hence Fasnacht. At that time he faced 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 information, 28 centers from 16 European countries and two centers from the United States have joined. The self-imposed minimum score of 2,014 study participants was quickly reached and eventually 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 which a dexamethasone test was used to determine if the tumor was producing 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, the medical examination shows that the affected person is seriously ill. There is no doubt that there is a need for quick action here.”observes the scientist.
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 the age of 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 children. men over 65 “.
But why is this so? It could be because of the protection women generally have up to ten years after menopause, for example when it comes to cardiovascular disease. They are generally healthier than men and also have a longer life expectancy.
“The healthier the patients, the more important the role of cortisol”, according to Priv.-Doz. Dr Timo Deutschbein, associate researcher at the Chair of Endocrinology and first author of the publication.
“If young women had a significantly increased risk profile regardless of cortisol, for example diabetes, hypertension, 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 the follow-up studies. It is also necessary to examine the causal relationship between excess cortisol and higher mortality.
Finally, mortality could also be related to a previously unknown factor that is responsible for adrenal tumor development and growth and which “only incidentally” leads to increased cortisol release.
In the future, it is important to check who surgery or drug treatment may be recommended. “Some of the patients would probably benefit from an operation or drug treatment”, Fassnacht revises his initial opinion. (A.D)
Information on the author and source
This text corresponds to the requirements of the specialist medical literature, medical guidelines and current studies and has been verified by medical professionals.
- University Hospital of Würzburg: Keep an eye on adrenal tumors, (access: 08.05.2022), University Hospital of Würzburg
- 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
This article contains general advice only and is not to be used for self-diagnosis or treatment. It cannot replace a visit to the doctor.