Increased risk of death from excess cortisol – healing practice

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 “healthy” adults have a tumor in the adrenal gland, with the frequency increasing with age. Researchers have now found that those affected risk of death in case of too much cortisol is increased.

An international multicenter study conducted in Würzburg shows that increased cortisol release from benign adrenal tumors is associated with increased mortality, especially in women under 65 years of age. The study results were published in the journal The Lancet Diabetes & Endocrinology.

Most adrenal tumors are benign

As explained in a recent report from the University Hospital of Würzburg (UKW), 3% of people over the age of 50 have adrenal tumors. Among those over 80, one in ten people are affected.

However, 80-90% of these tumors, which are usually discovered by chance, for example during a CT scan for gallbladder problems, kidney stones or back problems, are benign and assumed to be harmless.

Supposedly, because a slightly increased production of the hormone cortisol, which many of these tumors involve, divided opinion some time ago. Should the tumor be surgically removed or not?

No treatment needed?

Until recently, Prof. Dr. Martin Fassnacht, head of the department of endocrinology and diabetes at the UKW, is of the opinion that most benign adrenal tumors do not need to be treated, only those that lead to severe hormonal 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 was not enough for us, we wanted to know exactly”, so Fastnacht. At that time, he raised the assumption that the clinical picture should be ignored in most affected individuals and encouraged his European colleagues to conduct a large cohort study called NAPACA Outcome.

According to reports, 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 whom a dexamethasone test was used to determine if the tumor was producing more of cortisol.

Patients with malignancies and clinically recognizable hormonal excess such as Cushing’s syndrome were excluded. “In the case of Cushing’s syndrome, the medical examination shows the person affected that they are seriously ill. There is no doubt that there is a need to act quickly 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 excess cortisol were four times more likely to die than women without excess cortisol. Interestingly, the latter hardly seems to play a role for men over 65.

But why is it like this? This could be due to the protection that women generally enjoy up to and ten years after menopause, for example with regard to cardiovascular diseases. They are generally healthier than men and also have a longer life expectancy.

“The healthier the patients, the more relevant the role of cortisol”, according to Priv.-Doz. Doctor Timo Deutschbein, research associate at the Chair of Endocrinology and first author of the publication.

“If young women had a significantly increased risk profile independent of cortisol, such as diabetes, high blood pressure, obesity and nicotine use, 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, the mortality could also be linked to a hitherto unknown factor which is responsible for the development and growth of the adrenal tumor and which leads “only incidentally” to an increase in the release of cortisol.

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 surgery or drug treatment”, Fassnacht revises its initial opinion. (ad)

Author and source information

This text corresponds to the requirements of the specialized medical literature, medical guidelines and current studies and has been verified by health professionals.

Sources:

  • University Hospital Würzburg: Keep an eye out for adrenal tumors, (accessed: 08.05.2022), University Hospital Würzburg
  • Disparity in mortality by age and sex in patients with adrenal incidentaloma and autonomic cortisol secretion: a retrospective international cohort study; in: The Lancet Diabetes & Endocrinology, (published: 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. It cannot substitute a visit to the doctor.

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