New research could enable better healthcare for patients with benign tumours of the adrenal glands. Researchers at Lund University in Sweden have identified the levels of cortisol produced by the tumours which are associated with higher mortality rates.
Up to half of benign adrenal tumours produce excessive amounts of the hormone cortisol. Until now, researchers did not know at which levels the cortisol could be harmful or even fatal for the patient.
In a study published in the Annals of Internal Medicine, researchers at Lund University and Skåne University Hospital followed up all patients diagnosed with benign adrenal tumours who came into contact with Skåne University Hospital or Helsingborg Hospital between 2005 and 2015, a total of just over 1 000 patients.
The researchers collected data about the degree of cortisol production in the tumours. The patients were then divided into four groups, based on the degree of cortisol overproduction, from no overproduction to high. The difference in mortality between the groups was investigated using national registers on cause of death.
"The results show a clearly increased risk of death in the two groups with the highest production of cortisol. The risk is 2-3 times higher than for patients with normal cortisol production and the main cause of increased risk is cardiovascular disease", says Albin Kjellbom, consultant physician in endocrinology and diabetology at Skåne University Hospital and research student at Lund University.
The groups with increased risk make up around 20 per cent of patients in the study, i.e. about 200 people.
The results also show that many patients whose tumours have a lower level of cortisol production do not have an increased risk of death.
"In the future, we will be able to identify the patients with an increased risk of death and concentrate our efforts on them, while being able to reassure a large group of patients. This also means a better use of public healthcare resources", says Albin Kjellbom.
There are currently two treatment strategies available for patients with benign adrenal tumours. Either the tumours are surgically removed, or treatment focuses on the known risk factors for cardiovascular disease such as high blood pressure and diabetes.
"We actually know very little about which treatment is effective for these patients; so far, this has not been sufficiently studied. Nor is this something that our study can answer, but now that we are able to identify the patients with an increased risk of death, future studies can investigate which treatment is effective in reducing risk in this patient group", concludes Albin Kjellbom.
Annals of Internal Medicine