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Impaired glucose metabolism in primary aldosteronism is associated with cortisol co-secretion.

J. Clin. Endocrinol. Metab., accepted (2019)
Postprint online available 03/2020 Open Access Green as soon as is submitted to ZB.
CONTEXT: Primary aldosteronism (PA) is associated with higher cardiovascular morbidity and metabolic risks. Recent studies report glucocorticoid co-secretion as a relevant phenotype of PA, which could contribute to associated risks, including type 2 diabetes mellitus (T2DM). The relationship between autonomous cortisol secretion (ACS) and glucose metabolism in PA has not been investigated. OBJECTIVE: To evaluate the prevalence of impaired glucose homeostasis in PA patients according to cortisol co-secretion. METHODS: We performed oral-glucose-tolerance-tests (OGTT) and complete testing for hypercortisolism (1mg-dexamethasone-suppression-test (DST), late-night-salivary-cortisol (LNC), 24hour-urinary-free-cortisol (UFC)) in 161 newly diagnosed PA patients of the German Conn Registry. 76 of 161 patients were reevaluated at follow-up. We compared our results to a population-based sample from the KORA-F4 study matched to the PA participants (3:1) by sex, age, and BMI. RESULTS: At the time of diagnosis, 125 patients (77.6%) had a pathological response in at least one of the Cushing screening tests; T2DM was diagnosed in 6.4% of these 125 cases. Patients with pathological DST exhibited significantly higher 2h plasma glucose in OGTT and were significantly more often diagnosed with T2DM than patients with normal DST (20% vs. 0.8%, p<0.0001) and matched controls from the KORA study (20.6% vs. 5.9%.; p=0.022). PA patients without ACS tended to have higher homeostatic-model-assessment-of-insulin-resistance (HOMA-IR) than KORA control subjects (p=0.05). CONCLUSION: ACS appears frequently in PA patients and is associated with impaired glucose metabolism, which could increase the risk of T2DM. PA itself seems to enhance insulin resistance.
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Publication type Article: Journal article
Document type Scientific Article
Reviewing status