Abstract-An association between primary aldosteronism and metabolism disorders has been reported. The aim of this retrospective study was to test for this association by comparison between large cohorts of patients with primary aldosteronism and with essential hypertension. We retrieved the records of 460 cases with primary aldosteronism (103 lateralized, 150 not lateralized, and 207 undetermined) and of 1363 controls with essential hypertension individually matched for age and sex. We compared clinical history; blood pressure levels; body mass index; levels of fasting plasma glucose and serum triglycerides; total, high-density lipoprotein, and low-density lipoprotein cholesterol; and the prevalence of diabetes mellitus and impaired fasting glucose among subtypes of primary aldosteronism, as well as between cases with primary aldosteronism and their matched controls. Fasting plasma glucose and serum lipid levels did not differ among the 3 subtypes of primary aldosteronism. The prevalence of impaired fasting glucose was lower in patients with primary aldosteronism than their matched controls, but the prevalence of hyperglycemia (impaired fasting glucose or diabetes mellitus) and blood levels of glucose and lipids did not differ between cases and controls.There was no significant difference between preoperative and postoperative levels of either fasting plasma glucose or serum lipids in patients who underwent adrenalectomy and had follow-up data available. The analysis of this large group of patients with primary aldosteronism and essential hypertension does not confirm a higher prevalence of carbohydrate or lipid metabolism disorders in the former. It is unlikely that the prevalence of metabolic syndrome differs significantly between patients with primary aldosteronism and those with essential hypertension. Key Words: diabetes mellitus Ⅲ hyperaldosteronism Ⅲ primary Ⅲ hyperlipidemia Ⅲ hypertension, essential P rimary aldosteronism (PA) is the most frequent form of endocrine hypertension. 1 Patients with PA have a higher prevalence of cardiovascular 2-5 and renal 6,7 complications than patients with essential hypertension with similar levels of blood pressure; this suggests that excess aldosterone has harmful nonhemodynamic cardiovascular and renal effects. 8,9 An association between PA and carbohydrate metabolism disorders was reported by Conn as long ago as 1965, 10 and aldosterone-producing adenoma is mentioned as a possible cause for diabetes mellitus by the American Diabetes Association. 11 A higher prevalence of metabolic abnormalities, like impaired glucose and lipid metabolism or the metabolic syndrome, might contribute to the higher cardiovascular and renal risk in patients with PA than in patients with essential hypertension. Several mechanisms for glucose and lipid metabolism impairments in PA have been discussed, including a diabetogenic effect of hypokalemia and effects of aldosterone on the insulin receptor or on adipose tissue metabolism. 12,13 However, previous studies of the prevalence of glucose ...

Abstract-Unilateral primary aldosteronism is the most common surgically correctable form of endocrine hypertension and is usually differentiated from bilateral forms by adrenal venous sampling (AVS) or computed tomography (CT

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Endothelial function is impaired in patients with pheochromocytoma as indicated by the elevated circulating levels of ADMA and sVCAM-1. The lack of association of these markers with cateholamines, glucose and lipid abnormalities together with their comparable levels in EH patients suggests that endothelial dysfunction is most likely related to hypertension itself.

BackgroundRecent studies have revealed a higher rate of cardiovascular complications in primary aldosteronism (PA) compared to patients with essential hypertension (EH). Asymmetric dimethylarginine (ADMA) is a marker of endothelial dysfunction that could contribute to increased cardiovascular risk in patients with PA.ObjectivesThe aim of this study was to compare the levels of ADMA among patients with PA, controls with EH and healthy participants. Methods: Serum ADMA levels were determined, using commercially available competitive enzyme-linked immunosorbent assay.MethodsSerum ADMA levels were determined, using commercially available competitive enzyme-linked immunosorbent assay.ResultsPatients with PA had significantly higher concentrations of ADMA than healthy controls (0.488 ± 0.085 vs. 0.433 ± 0.053 μmol/L, P = 0.027). No difference was found in ADMA levels between cases with PA and EH (0.488 ± 0.085 vs. 0.476 ± 0.075 μmol/L, р = 0.636). The difference between patients with EH and normotensive controls did not reach statistical significance (P = 0.06).ConclusionsThe lack of difference between ADMA levels in patients with PA and EH suggests that endothelial dysfunction is more likely related to hypertension per se than to the specific etiology of elevated blood pressure.

AbstractPrimary aldosteronism (PA) has long been considered a rare disease, but a higher prevalence was suggested recently. The aim of this study was to evaluate the prevalence of PA in a group of Bulgarian hypertensive patients, including patients with adrenal incidentalomas (AI). The aldosterone to renin ratio (ARR)>750 was used as a positive screening test and the Captopril test was performed to confirm the diagnosis. Adrenal CT scan was used to differentiate between the main subtypes of PA- aldosterone-producing adenoma (APA) and idiopathic hyperaldosteronism (IHA). The diagnosis of APA was retrospectively confirmed after surgery. After excluding other forms of endocrine hypertension, except PA, we investigated a total of 472 consecutive hypertensive patients, among them 96 patients with AI. Final diagnosis of PA was reached in 38 patients (8.05%) in the entire hypertensive population and in 12 patients (12.5%) among hypertensive patients with AI. In the group of PA, 15 patients (39.5%) were diagnosed with APA and 23 patients (60.5%) had an IHA. Among all patients with PA 21 (55.3 %) presented with hypokalemia. Our findings of a relatively high prevalence of PA support an early diagnosis of this potentially curable disease, especially in hypertensive patients with AI.

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