MACS was associated with epicardial adiposity and an adverse cardio-metabolic risk profile, while even non-functioning adrenal adenoma patients showed intermediate cardio-metabolic risk compared to controls without adrenal tumors.
Epicardial adipose tissue area was significantly highest in MACS patients, followed by NFA, with lowest values in controls.
The prevalence of hypertension was significantly different between groups, being highest in MACS and lowest in controls.
Dyslipidemia prevalence was significantly different across the three groups, with MACS patients having the highest prevalence.
Prediabetes prevalence was significantly different between groups, with NFA patients having the highest rate, followed by MACS and then controls.
Markers of glucose metabolism were significantly worse in MACS patients and best in controls, with NFA patients showing intermediate values.
No relevant between-group differences were found in cardiac morphology, intramyocardial fat, or intrahepatic fat.
The study included 74 individuals across three groups matched for sex and broadly similar in age and BMI.
This research suggests that people with adrenal gland tumors — even those that don't produce excess hormones — have worse heart and metabolic health compared to people without adrenal tumors. The study compared three groups: those with mild autonomous cortisol secretion (MACS, where the tumor releases small amounts of the stress hormone cortisol without typical symptoms), those with non-functioning adrenal adenomas (NFA, tumors that don't release excess hormones), and healthy controls with no adrenal tumors. Using MRI, blood tests, and glucose tolerance tests, the researchers found that MACS patients had the most fat surrounding their hearts (epicardial fat), the highest rates of high blood pressure, and the worst blood sugar control, while controls had the healthiest profiles and NFA patients fell in between. One striking finding was that fat deposits specifically around the heart — known as epicardial adipose tissue — were dramatically different between groups, even though fat inside the heart muscle and liver did not differ significantly. Epicardial fat is considered a risk factor for heart disease, and MACS patients had nearly double the epicardial fat of controls. High blood pressure was present in 84% of MACS patients compared to 44% of controls, and abnormal blood sugar regulation (prediabetes) was surprisingly common even in the NFA group (72%), suggesting that having any adrenal tumor may carry metabolic risks beyond those already known for cortisol-secreting tumors. This research suggests that adrenal adenomas — including those previously considered 'non-functioning' — may not be as benign as once thought from a heart and metabolic health standpoint. The findings highlight the importance of monitoring cardiovascular and metabolic risk factors in all patients with adrenal tumors, not just those with measurable hormone excess. Because this was a cross-sectional study (a snapshot in time), it cannot prove that the tumors caused these health problems, but the stepwise pattern from controls to NFA to MACS patients points toward a meaningful biological relationship worth investigating further.
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Upload Your LabsNiziolek H, Just I, Tosin A, Baumgartner C, Koldyka O, Körmöczi K, et al.. (2026). Adverse cardio-metabolic risk profile and epicardial adiposity in patients with adrenal adenoma: a cross-sectional study.. Frontiers in endocrinology. https://doi.org/10.3389/fendo.2026.1898271