Cortisol. We have often called it the “stress hormone”. But more generally, it is fundamental for the regulation of metabolism, blood pressure and the immune response and, when it is produced in excess, it can favor the onset of cardiovascular and metabolic complications.
On the research front, an Italian study now sheds light on how cortisol secretion in patients with benign adrenal tumors is not as stable as previously thought and can change over time, influencing the risk of worsening arterial hypertension and a higher overall burden of cardiometabolic risk factors.
This is according to an international study published in The Lancet Diabetes & Endocrinologywhich redefines the natural history of these tumors and opens new perspectives for the clinical monitoring of patients. The work bears the first signature of Giuseppe Reimondo, of the Department of Clinical and Biological Sciences of the University of Turin and of Internal Medicine – Endocrinology of the AOU San Luigi Gonzaga of Orbassano, directed by Massimo Terzolo, ENSAT Center of Excellence for the diagnosis, treatment and research on adrenal tumors.
Tailored exams
The study, the largest ever carried out on the evolution of cortisol secretion in patients with benign adrenal tumors, involved 2,525 patients followed for an average period of almost seven years in 25 specialist centers in 14 countries, as part of the European Network for the Study of Adrenal Tumors (ENSAT).
Benign adrenal tumors, often discovered accidentally during radiological tests performed for other reasons, affect approximately 3-7% of the adult population. Some of these produce excess cortisol, even in the absence of the typical symptoms of Cushing’s syndrome, resulting in a condition known as Mild Autonomous Cortisol Secretion (MACS). Until now, clinical practice was based on the idea that a single hormonal test was generally sufficient to define the patient’s endocrine profile.
The results of the study show that cortisol secretion changes over time in more than one patient in five: 22% of the subjects observed changed their hormonal profile during follow-up and the majority of these changes occurred within the first three years after diagnosis. This is a result that calls into question the paradigm adopted so far and suggests the usefulness of a periodic reassessment in a significant proportion of patients.
The research also identified patients with persistent cortisol excess as the group at greatest clinical risk. In these patients, a 34% increase in the risk of worsening of arterial hypertension was observed compared to those who have consistently normal cortisol values. Over a ten-year period, these patients average about two years less without worsening of hypertension, a clinically relevant difference that highlights the importance of more accurate monitoring and timely control of modifiable cardiovascular risk factors.
Hormones regulate health
Hormones are the “registers” of our health, but half of Italians don’t know it. These are biological messengers produced by endocrine glands such as the pituitary gland, thyroid, pancreas, testes and ovaries. But also from any other tissue and organ in our body: adipose tissue, stomach and intestine, heart, kidneys, skin, lungs and bone.
There are many dozens of different types of hormones, such as insulin, testosterone, cortisol, estrogen, prolactin, adrenaline, thyroid hormones, melatonin, leptin, growth hormone, and many others. Each of them has a very specific function: they are essential for dealing with stress, growing, regulating metabolism, determining sexual function and fertility, but also for cognitive processes and general well-being. They tell us when to go to sleep, when to stop eating, how to regulate body pressure.
Hormonal imbalance can lead to the development of 30% of the most widespread chronic pathologies, in which the environmental component is also fundamental, but which in many cases can be prevented such as diabetes mellitus, obesity, arterial hypertension, osteoporosis, thyroid diseases, growth disorders, infertility and sexual dysfunctions.
