Healthcare Guidelines

Healthcare Guidelines; Global guidelines on managing the care of patients diagnosed with common types of adrenal tumours should be updated, say researchers following a study carried out by an international collaboration. The research, a systematic review and meta-analysis published in Annals of Internal Medicine, is a collaboration between the University of Birmingham part of Birmingham Health Partners (BHP) in the UK and the Mayo Clinic in the US.

The Healthcare Guidelines

It was support by the National Institute for Health Research Birmingham Biomedical Research Centre. The researchers review 32 studies reporting the outcomes of more than 4,000 patients who had non cancerous tumours that were class as either non functioning adrenal tumours (NFAT) or tumours causing mild autonomous cortisol excess (MACE).

Adrenal tumours are found in the adrenal glands part of the body’s endocrine system; which releases hormones to the blood system that play a key role in how bodies process nutrients; so respond to stress and regulate sexual development and function. There are two adrenal glands, one on the top of each kidney. A major hormone release by the adrenals is cortisol, a hormone that helps to regulate blood pressure; so metabolism and the body’s reaction to stress.

However, while common, most adrenal tumours are benign; but it is important to determine which; if any, will develop into something more serious, such as cancer or Cushing’s syndrome. Currently the typical approach to treating patients with adrenal tumours is to remove; so them surgically if there is severe hormone overproduction or suspicion of cancer.

Increased risk of death

There is also a concern that MACE may evolve into overt Cushing’s syndrome; so with all its complications, such as high blood pressure, obesity, diabetes and increase risk of death. However, whether these tumours should be surgically remove is controversial due to limit research evidence.

They also found that development of overt Cushing’s syndrome during follow-up does not occur; so neither in patients with NFAT or MACE. Finally, they found that patients with NFAT, but in particular patients with MACE, present with a high prevalence and incidence of cardiovascular illness or death.

However, both patients with NFAT and those with MACE should have clinical check-ups in larger but regular intervals, paying attention to the patients’ metabolic health due to their increase risk of hypertension, type 2 diabetes, and cardiovascular disease. The European Society of Endocrinology clinical practice guideline currently recommends annual assessment for cortisol excess in patients with MACE, we would suggest this recommendation may need review and possibly revision in light of our endings.