Impaired Glucose Metabolism in Primary Aldosteronism Is Associated With Cortisol Cosecretion
Open accessAbstract
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 hypercortisolism [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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Management of Primary Aldosteronism
Drake, W. M., & Brown, M. J. (2022) · doi:10.1093/med/9780198870197.003.0100
- Authors
- 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.
- Affiliations
- Endokrinologie in Charlottenburg, Berlin, Germany
- LMU Klinikum (DE)
- Helmholtz Munich (DE)
- Deutsches Diabetes-Zentrum e.V. (DE)
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany
- Corresponding author
- Quinkler, Marcus
- ORCID
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2019-03-13
- Volume
- 104
- Issue
- 8
- Pages
- 3192-3202
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2922008461
- Semantic Scholar
- a524ca8333cd0d6c9b307016263a2d2cb8b2728a
- Cited by
- 112
- References
- 49
- Citations by year
- 2026: 8 · 2025: 18 · 2024: 15 · 2023: 15 · 2022: 17 · 2021: 14 · 2020: 16 · 2019: 9
- FWCI
- 11.40
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, other-oa)
- Site cant be reached (submittedVersion, cc-by)
- PuSH - Publication Server of Helmholtz Zentrum München (submittedVersion)
- OPUS (Augsburg University) (submittedVersion)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion, other-oa)
- Zurich Open Repository and Archive (University of Zurich)
- Funders
- Else Kröner-Fresenius-Stiftung (2013_A182 and 2015_A171)
- European Research Council (694913)
- Deutsche Forschungsgemeinschaft (CRC/Transregio 205/1)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal Regulation and Hypertension
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
- Keywords
- primary aldosteronism, autonomous cortisol secretion, hypercortisolism, impaired glucose homeostasis, type 2 diabetes, insulin resistance, dexamethasone suppression test, late-night salivary cortisol, urinary free cortisol, oral glucose tolerance test, cardiovascular risk
- MeSH terms
- Adult, Aged, Diabetes Mellitus, Type 2, Female, Glucose, Glucose Tolerance Test, Humans, Hydrocortisone, Hyperaldosteronism, Insulin Resistance, Male, Middle Aged
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