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Nonfunctional adrenal tumors significantly increase risk for diabetes

August 01, 2016

1. Patients with "nonfunctional" adrenal tumors at significantly higher risk for diabetes
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Patients with nonfunctional adrenal tumors have a significantly higher risk for diabetes compared to patients without adrenal tumors. These findings suggest that a classification of "nonfunctional" may not adequately describe the continuum of hormone secretion and metabolic risk associated with benign adrenal tumors. The study is published in Annals of Internal Medicine.

Adrenal tumors are typically benign and affect up to 10 percent of the population. While benign adrenal tumors are commonly thought to be nonfunctional, a substantial proportion may be functional in that they secrete detectable adrenocortical hormones. Known as subclinical hypercotisolism, the condition is associated with hypertension, insulin resistance, type 2 diabetes, hyperlipidemia, osteoporosis, and obesity. In recent studies, subclinical hypercotisolism was linked to an increased risk for cardiovascular events and death compared to nonfunctional adrenal tumors. Therefore, screening for hypercortisolism is recommended for all patients with adrenal tumors. However, emerging evidence suggests that nonfunctional adrenal tumors may be associated with cardiometabolic disease.

Researchers compared medical records for 166 patients with benign nonfunctional adrenal tumors to those of 740 patients with no adrenal tumor to look for development of cardiometabolic outcomes, such as hypertension, diabetes, or cardiovascular events. They found that patients with nonfunctional adrenal tumors were significantly more likely to develop diabetes than those without adrenal tumors. These findings suggest that nonfunctional adrenal tumors may warrant more clinical attention and should be considered an independent risk factor for diabetes.

Note: For an embargoed PDF, please contact Cara Graeff. To reach the lead author, Dr. Anand Vaidya, please contact Haley Bridger at or 617-525-6383.

2. Trend report: No increase in overall prevalence of late stage chronic kidney disease over the past decade
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In a reversal of previous trends, no increase in the prevalence of stage 3 and 4 chronic kidney disease (CKD) has been seen in the U.S. population over the most recent decade. The findings are published in Annals of Internal Medicine.

CKD is recognized as an important risk factor for end-stage renal disease, acute kidney injury, cardiovascular disease, and premature death. As such, national health programs, such as the U.S. Department of Health and Human Services' Healthy People 2020 initiative, have set a target of a 10 percent proportional reduction in CKD prevalence in the U.S. population. While peer-reviewed publications have mostly reported that the overall prevalence of CKD in the U.S. population had been increasing by as much as 5 percent per year, it has been noted that the incidence rate of end-stage renal disease, which is almost always preceded by CKD, have been decreasing since the early 2000s. However, an important limitation in the peer-reviewed literature is that CKD prevalence in more recent years has not been analyzed.

Researchers analyzed data from the national Health and Nutrition Examination Survey (NHANES) to estimate the trends in CKD prevalence overall and in subgroups of the population, with particular attention given to more recent years. They found that stage 3 and 4 CKD has not increased appreciably in the U.S. population overall during the most recent decade. The lack of increase was noted in most subgroups examined when data were stratified by age, sex, race/ethnicity, and diabetes status, except for among non-Hispanic black persons. The authors express concern over these findings and suggest further research to better understand potentially important differences in patterns by racial/ethnic subgroups. The research could help to inform strategies for improving CKD prevalence trends for all population groups.

Note: For an embargoed PDF, please contact Cara Graeff. The lead author, Dr. Chi-yuan Hsu, can be reached through Katherine "Leigh" Beeson at

3. Patients should weigh benefits and risks when medication to reduce breast cancer risk is recommended
Annals of Internal Medicine and Beth Israel Deaconess Medical Center go "Beyond the Guidelines" to discuss pharmacological interventions to reduce breast cancer risk
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Should a 51 year-old woman with a strong family history of breast cancer be offered medication to reduce her own breast cancer risk? An oncologist and an internist debate the topic in a multicomponent educational article being published in Annals of Internal Medicine.

Clinical guidelines from the U.S. Preventive Services Task Force recommend that physicians discuss treatment with selective estrogen receptor modulators (tamoxifen, raloxifene) with their postmenopausal patients that have an increased 5-year risk for breast cancer, as the benefits of treatment may outweigh the potential harms. Similarly, the American Society of Clinical Oncology recommends that women aged 35 years or older at increased risk for breast cancer discuss the use of preventative medications, including the aromatase inhibitor exemestane, which is not approved by the FDA for this purpose, with their primary care providers. In this Beyond the Guidelines article, an oncologist and a primary care physician debate whether or not to prescribe pharmacotherapy for a premenopausal patient who does not fit exactly within guideline parameters. Both physicians agree that shared decision making is essential and must include informing the patient of the specific benefits and risks associated with treatment.

All Beyond the Guidelines papers are based on the Department of Medicine Grand Rounds at Beth Israel Deaconess Medical Center in Boston. Each session focuses on care of a patient who "falls between the cracks" in available evidence and for whom the optimal clinical management is unclear. Such situations include those in which a guideline finds evidence insufficient to make a recommendation, a patient does not fit criteria mapped out in recommendations, or different organizations provide conflicting recommendations. Debates are presented in a question and answer format, and include video interviews with the patient and physicians. A list of topics is available at

Note: For an embargoed PDF, please contact Cara Graeff. To interview the lead author, please contact Lizzie Williamson at or 617-632-8217.

Also in this issue:

Bioequivalence of Biosimilar Tumor Necrosis Factor-_ Inhibitors Compared With Their Reference Biologics: A Systematic Review and Meta-analysis
Francine Chingcuanco, MHS; Jodi Segal, MD, MPH; Seoyoung C. Kim, MD, ScD, MSCE; and G. Caleb Alexander, MD

The Biosimilarity Concept: Toward an Integrated Framework for Evidence Assessment
Issam Zineh, PharmD, MPH; Leah A. Christl, PhD

Annals Graphic Medicine - I'd Want a Natural Death
Nathan Gray, MD
Graphic Medicine
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Visceral Vistas: Basil Hirschowitz and the Birth of Fiberoptic Endoscopy
Ian S. Campbell, MD; Joel D. Howell, MD, PhD; and H. Hughes Evans, MD, PhD
History of Medicine

American College of Physicians

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