Doctors may need to rethink how they care for people with common adrenal tumors after a major international study found that hormone levels can change much more than previously expected.
The research, published in The Lancet Diabetes & Endocrinology, found that patients whose cortisol levels stayed high over time had a much greater risk of worsening high blood pressure and other heart-related health problems.
Cortisol is an important hormone made by the adrenal glands, which sit above the kidneys. It helps regulate blood pressure, blood sugar, energy use, inflammation, and the body’s response to stress.
Healthy people carefully control cortisol production through signals from the brain. However, some benign adrenal tumors produce cortisol on their own, even when the body no longer needs it. This condition is known as mild autonomous cortisol secretion, or MACS.
Benign adrenal tumors are common, especially in older adults, and are often discovered accidentally during scans performed for unrelated health problems. Because many people have no obvious symptoms, doctors usually rely on hormone testing to determine whether treatment or regular follow-up is needed.
Researchers from 25 adrenal centers across 14 countries studied 2,525 patients through the European Network for the Study of Adrenal Tumors. Participants were followed for nearly seven years on average.
During this period they repeatedly completed the overnight dexamethasone suppression test, the standard test used to check whether cortisol production is abnormally high.
The study showed that cortisol patterns changed in about one in five patients. Most of these changes happened during the first three years after diagnosis. This finding suggests that relying on only the first hormone test may overlook important changes that occur later.
Patients whose cortisol remained consistently elevated faced the greatest health risks. They experienced a 34% higher rate of worsening high blood pressure than patients whose cortisol remained normal.
Over ten years they also spent about two fewer years with well-controlled blood pressure. In addition, they had a greater cardiometabolic burden, meaning they were more likely to have combinations of obesity, diabetes, high cholesterol, and hypertension that increase the risk of heart attack, stroke, and heart failure.
The findings agree with earlier clinical trials showing that removing the adrenal tumor through surgery can improve blood pressure in carefully selected patients. Researchers believe that identifying people with persistent hormone overproduction may help doctors decide who should receive closer monitoring or more active treatment.
The study does not prove that persistent cortisol excess directly caused all of the health problems, but it provides strong evidence that the two are closely connected.
Because the research included thousands of patients from many countries and followed them over several years, its conclusions are more reliable than smaller earlier studies. Still, future research is needed to determine the best schedule for repeated hormone testing and whether earlier treatment improves long-term outcomes.
Overall, this research challenges a long-standing assumption in medicine. Rather than viewing cortisol levels as fixed after diagnosis, doctors may need to recognise that they often change over time. Better follow-up could help identify higher-risk patients earlier and reduce future cardiovascular complications.
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Source: University of Birmingham.
