User:Dr. Mende Mensa Sorato/sandbox

Shall we Screen for Mild autonomous cortisol secretion (MACS) for managing the three giants (Hypertension, diabetes, and Cancer) of healthcare in 22nd century? Chronic illnesses including cardiovascular diseases, diabetes, cancer and respiratory diseases are becoming the major global health challenges in both developed and developing countries. The burden in developing countries is of triple in nature (infectious disease, maternal and child malnutrition and chronic idleness). National and international health policies and are developed to address chronic illnesses together because of their shared distal and intermediate risk factors. Management of cardiovascular diseases like hypertension, diabetes and early screening and management of cervical cancer are considered under national strategic plans of every country (1). Non-communicable diseases (NCDs) were responsible for 71% of the 57million deaths occurred globally in 2016. CVDs accounted for 44% all NCD deaths. About 75% of adult deaths are premature. The global probability of dying from one of the four main NCDs in 2016 was 18% (males 22% & females 15%) (2). Non-communicable diseases have two known risk factors. These are; modifiable behavioral risk factors (tobacco use, physical inactivity, unhealthy diet, and the harmful use of alcohol and stress) and metabolic risk factors (raised blood pressure, overweight/obesity, hyperglycemia and dyslipidemia and non-modifiable (family history, genetic influence, epigenetic changes, age, gender, race, and ethnicity) (3). Hypertension is still leading global disease risk factor, in 2017, high systolic blood pressure (SBP) was the leading risk factor, accounting for 10.4 million deaths and 218 million DALYs, followed by smoking 7.10 million deaths and 182 million, high fasting plasma glucose 6.53 million deaths and 171 million DALYs, high body-mass index (BMI; 4.72 million deaths and 148 million DALYs (4). In addition to the above mentioned risk factors, the recent evidences indicated more strong association between benign adrenal tumors (adrenal incidentalomas) with hypertension and type 2 diabetes. In more than 15% of people with benign adrenal tumors, the growths produce clinically relevant levels of serum cortisol that are significantly linked with an increased prevalence of hypertension and, in 5% of those with Cushing syndrome (CS), an increased prevalence of type 2 diabetes. Mild autonomous cortisol secretion (MACS) from benign adrenal tumors is very frequent and is an important risk condition for high blood pressure and type 2 diabetes, especially in older women (5). All patients found to have a benign adrenal tumor should undergo testing for MACS and have their blood pressure and glucose levels measured regularly. The findings suggest that screening for MACS could help identify people particularly women, in whom the condition was found to be more common who may benefit from support to reduce their risk of type 2 diabetes. Researchers used a MACS definition of failure to suppress morning serum cortisol concentration to less than 50 nmol/L after treatment with 1mg oral dexamethasone at 11 PM the previous evening in those with no clinical features of CS. Roughly half of patients (n = 649) showed normal cortisol suppression with dexamethasone, identifying them as having nonfunctioning adrenal tumors, and about 35% showed possible MACS based on having moderate levels of excess cortisol (5). References 1.	Collaborators. GRF. Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 84 behavioral, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. . Lancet 2018;392:1923-94. 2.	WHO. Global Health Estimates 2016: Deaths by Cause, Age, Sex, by Country and by Region, 2000–2016. . 2018. 3.	Budreviciute A, Damiati S, Sabir DK, Onder K, Schuller-Goetzburg P, Plakys G, et al. Management and Prevention Strategies for Non-communicable Diseases (NCDs) and Their Risk Factors. Frontiers in Public Health. 2020;8. 4.	Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet (London, England). 2018;392(10159):1923-94. 5.	Prete A, Subramanian A, Bancos I, Chortis V, Tsagarakis S, Lang K, et al. Cardiometabolic Disease Burden and Steroid Excretion in Benign Adrenal Tumors. Annals of internal medicine. 2022.