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Gerards, J.* ; Heinrich, D.A.* ; Adolf, C.* ; Meisinger, C. ; Rathmann, W.* ; Sturm, L.* ; Nirschl, N.* ; Bidlingmaier, M.* ; Beuschlein, F.* ; Thorand, B. ; Peters, A. ; Reincke, M.* ; Roden, M.* ; Quinkler, M.*

Impaired glucose metabolism in primary aldosteronism is associated with cortisol cosecretion.

J. Clin. Endocrinol. Metab. 104, 3192-3202 (2019)
Publ. Version/Full Text Postprint DOI
Open Access Green
Context: Primary aldosteronism (PA) is associated with higher cardiovascular morbidity and metabolic risks. Recent studies report glucocorticoid cosecretion 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 patients with PA according to cortisol cosecretion.Design: We performed oral glucose tolerance tests (OGTTs) and complete testing for hyper-cortisolism [1-mg dexamethasone suppression test (DST), late-night salivary cortisol, 24-hour urinary free cortisol] in 161 newly diagnosed patients with PA of the German Conn Registry. Seventy-six of 161 patients were reevaluated at follow-up. We compared our results to a population-based sample from the Cooperative Health Research in the Region of Augsburg (KORA)-F4 study matched to the participants with PA (3:1) by sex, age, and body mass index.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 a pathological DST exhibited significantly higher 2-hour plasma glucose in OGTTs and were significantly more often diagnosed with T2DM than were patients with a normal DST (20% vs 0.8%, P < 0.0001) and matched controls from the KORA study (20.6% vs 5.9%, P = 0.022). Patients with PA without ACS tended to have higher homeostatic model assessment of insulin resistance levels than did KORA control subjects (P = 0.05).Conclusion: ACS appears frequently in patients with PA 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
Keywords Diabetes-mellitus; Insulin-resistance; Cushings-syndrome; Autonomous Cortisol; High Prevalence; Population; Diagnosis; Receptor; Excess; Secretion
ISSN (print) / ISBN 0021-972X
e-ISSN 1945-7197
Quellenangaben Volume: 104, Issue: 8, Pages: 3192-3202 Article Number: , Supplement: ,
Publisher Endocrine Society
Publishing Place Bethesda, Md.
Reviewing status Peer reviewed