Disclosures: The authors report no relevant financial disclosures.
May 09, 2022
2 min read

Greater adrenal gland volume seen for adults with vs. without type 2 diabetes

Disclosures: The authors report no relevant financial disclosures.
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Adrenal gland volume is greater among adults with type 2 diabetes than without diabetes and might serve as a biomarker of metabolic status, according to study findings.

Esther Askani

“Our results indicate that an increased adrenal gland volume is an indirect marker of impaired metabolic state,” Esther Askani, MD, of the department of diagnostic and interventional radiology at the University of Freiburg Faculty of Medicine in Germany, told Healio. “Given the rising burden of metabolic syndrome and diabetes worldwide, the significance of an early detection of risk factors and imaging-based biomarker offers a beneficial tool in prevention and treatment care.”

Mean adrenal gland volume is larger with diabetes or prediabetes than without diabetes
Adults with type 2 diabetes or prediabetes have a larger mean adrenal gland volume than those without diabetes. Data were derived from Askani E, et al. Diabetes Metab Res Rev. 2022;doi:10.1002/dmrr.3528.

Askani and colleagues analyzed data from 375 adults participating in an MRI substudy from June 2013 to September 2014 nested within the Cooperative Health Research in the Augsburg Region, Germany (KORA) prospective cohort (58.5% men; mean age, 56.1 years). Total adrenal gland volume was calculated as the sum of the left and right adrenal glands. Participants without a type 2 diabetes diagnosis underwent an oral glucose tolerance test and had fasting plasma glucose measured.

Of the study cohort, 13.6% had type 2 diabetes and 25.3% were classified as having prediabetes. The average size of both the left and right adrenal glands was 5.6 mL, for a total adrenal gland volume of 11.2 mL. Adults with type 2 diabetes had a larger total adrenal gland volume (13.9 mL) compared with those with prediabetes (12.5 mL) and those without diabetes (10 mL; P < .001).

After adjusting for age, sex, hypertension, triglyceride level and BMI, each 1 mL increase in adrenal gland volume was associated with an increased risk for type 2 diabetes (adjusted OR = 1.13; 95% CI, 1-1.28; P = .045).

“Type 2 diabetes, among other metabolic disorders, is considered to constitute a stressful metabolic state, which induces chronic activation of the hypothalamic-pituitary-adrenal axis, and in turn chronic activation of the hypothalamic-pituitary-adrenal axis increases the volume of adrenal glands due to trophic effects of adrenocorticotropic hormone on the adrenal glands, which results in hypersecretion of glucocorticoids,” Askani said. “In turn, increased glucocorticoid levels can cause a hyperglycemia state and insulin resistance.”

Each 1 mL increase in adrenal gland volume was associated with an increased risk for prediabetes after adjusting for age, sex, hypertension and triglyceride level (aOR = 1.11; 95% CI, 1.02-1.2; P = .012). However, no difference in prediabetes risk was found after adjusting for BMI.

Askani said future research should focus on automatic segmentation of adrenal gland volume as well as the interlinks between adrenal gland volume and hypothalamic-pituitary-adrenal axis to further knowledge on the development of metabolic diseases. Large-scale studies are also needed to determine whether looking at adrenal volume to assess metabolic risk has clinical utility.

For more information:

Esther Askani, MD, can be reached at esther.askani@uniklinik-freiburg.de.