Impact of primary aldosteronism on renal function in patients with type 2 diabetes

Katsuragawa, Sho; Tsurutani, Yuya; Takiguchi, Tetsuya; Saito, Jun; Nishikawa, Tetsuo

doi:10.1111/jdi.13332

Cited by 6 publications

(6 citation statements)

References 36 publications

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“…26 PA has also been shown to be an independent risk factor for renal dysfunction in patients with type 2 diabetes and vice versa. 26,27 The low rate of screening for PA in the diabetic clinic will most likely lead to missed diagnosis of PA and subsequent opportunity for targeted treatment, BP optimisation and cardiovascular risk reduction. There is a lack of specific advice on PA detection in current diabetes management guidelines.…”

Section: Discussionmentioning

confidence: 99%

Screening for primary aldosteronism in the diabetic population: a cohort study

Tan

Libianto

Yang

et al. 2022

Internal Medicine Journal

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Background: Primary aldosteronism (PA) is the most common endocrine cause of hypertension. It is associated with higher cardio-metabolic risk than essential hypertension. Hypertension is common in patients with type 2 diabetes who carry increased cardiovascular risk; however, it is unknown how frequently they are tested for PA.Aim: To assess the extent to which the Endocrine Society's 2016 PA screening guidelines have been applied in a tertiary diabetes care setting and evaluate the demographic, clinical and biochemical characteristics of patients who met screening criteria compared with those who did not.Methods: This is a retrospective cohort study. Data were collected from 272 patients who attended tertiary diabetes clinics and had two or more blood pressure measurements from January to December 2018.Results: Of 272 patients, 60 (22.1%) had indication(s) for PA screening, but only 14 (23.3%) of 60 were screened using the aldosterone-to-renin ratio (ARR). Five patients who did not meet screening criteria were screened. Only one of 19 patients screened had an abnormal ARR; however, 16 were taking medications known to affect aldosterone and/or renin production.Conclusions: In a tertiary diabetes outpatient setting, only a minority of patients who fulfilled the Endocrine Society criteria for PA screening were actually screened. Appropriate screening for PA in the diabetic hypertensive population is necessary for the diagnosis and targeted treatment of a highly modifiable cardiovascular risk factor. Further studies are needed to develop feasible strategies to identify patients with PA in this population.

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Section: Discussionmentioning

confidence: 99%

Screening for primary aldosteronism in the diabetic population: a cohort study

Tan

Libianto

Yang

et al. 2022

Internal Medicine Journal

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“…Morning blood samples were collected after the patients had rested for 30 minutes. PACs, serum cortisol concentrations, and PRAs were measured using radioimmunoassays as previously described [ 14 , 15 ] and standardly used [ 9 , 10 , 16 ].…”

Section: Methodsmentioning

confidence: 99%

Characteristics of aldosterone-producing adenomas in patients without plasma renin activity suppression

et al. 2022

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Primary aldosteronism (PA) usually accompanies suppressed plasma renin activity (PRA) through a negative feedback mechanism. While some cases of PA with unsuppressed PRA were reported, there have been no studies about the characteristics of PA with unsuppressed PRA; thus, these characteristics were examined herein. Nine patients with unsuppressed PRA and 86 patients with suppressed PRA were examined. All patients underwent segmental adrenal venous sampling (sAVS) and adrenalectomy, and were pathologically confirmed to have cytochrome P450 11B2 (CYP11B2)-positive aldosterone-producing adenoma according to international histopathology consensus criteria. Unsuppressed and suppressed PRA were defined as PRA levels of > 1.0 and ≤ 1.0 ng/mL/hr, respectively, in multiple blood samples obtained in the resting position. The unsuppressed PRA group had higher morning cortisol levels (12.6 [8.5, 13.5] vs. 8.5 [7.1, 11.0] μg/dL, P = 0.03) and higher cortisol levels after a 1 mg dexamethasone suppression test (DST) (2.2 [1.6, 2.5] vs. 1.3 [1.0, 1.9] μ g/dL, P = 0.004) than the suppressed PRA group. The unsuppressed PRA group also showed higher aldosterone levels on the non-surgical side during sAVS (P = 0.02 before adrenocorticotropic hormone (ACTH) stimulation, P = 0.002 after ACTH stimulation), a higher intensity of CYP17 expression in the resected adrenal gland (P = 0.02), and a lower clinical complete success rate 1 year after surgery (P = 0.04) compared with those in the suppressed PRA group. These findings suggest that PA should not be ruled out by unsuppressed PRA among patients with hypertension, particularly when their cortisol levels remain unsuppressed in the 1 mg DST. Meanwhile, it should be acknowledged that patients with unsuppressed PRA have higher aldosterone levels on the non-surgical side, and a lower likelihood of postoperative complete clinical success is to be expected.

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“…PA patients are at higher risk for renal damage when compared to individuals with essential arterial hypertension, especially if a patient is diabetic [ 54 , 55 , 56 ]. The co-presence of ACS aggravates the renal dysfunction [ 57 , 58 ].…”

Section: Approach Of Connshing Syndromementioning

confidence: 99%

The Entity of Connshing Syndrome: Primary Aldosteronism with Autonomous Cortisol Secretion

Cârșote¹

2022

Diagnostics

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Connshing syndrome (CoSh) (adrenal-related synchronous aldosterone (A) and cortisol (C) excess) represents a distinct entity among PA (primary hyperaldosteronisms) named by W. Arlt et al. in 2017, but the condition has been studied for more than 4 decades. Within the last few years, this is one of the most dynamic topics in hormonally active adrenal lesions due to massive advances in steroids metabolomics, molecular genetics from CYP11B1/B2 immunostaining to genes constellations, as well as newly designated pathological categories according to the 2022 WHO classification. In gross, PA causes 4–10% of all high blood pressure (HBP) cases, and 20% of resistant HBP; subclinical Cushing syndrome (SCS) is identified in one-third of adrenal incidentalomas (AI), while CoSh accounts for 20–30% to 77% of PA subjects, depending on the tests used to confirm autonomous C secretion (ACS). The clinical picture overlaps with PA, hypercortisolemia being mild. ACS is suspected in PA if a more severe glucose and cardiovascular profile is identified, or there are larger tumours, ACS being an independent factor risk for kidney damage, and probably also for depression/anxiety and osteoporotic fractures. It seems that one-third of the PA-ACS group harbours mutations of C-related lines like PRKACA and GNAS. A novel approach means we should perform CYP11B2/CYP11B1 immunostaining; sometimes negative aldosteronoma for CYP11B1 is surrounded by micronodules or cell clusters with positive CYP11B1 to sustain the C excess. Pitfalls of hormonal assessments in CoSh include the index of suspicion (check for ACS in PA patients) and the interpretation of A/C ratio during adrenal venous sample. Laparoscopic adrenalectomy is the treatment of choice. Post-operative clinical remission rate is lower in CoSh than PA. The risk of clinically manifested adrenal insufficiency is low, but a synthetic ACTH stimulating testing might help to avoid unnecessary exposure to glucocorticoids therapy. Finally, postponing the choice of surgery may impair the outcome, having noted that long-term therapy with mineralocorticoids receptors antagonists might not act against excessive amounts of C. Awareness of CoSh improves management and overall prognosis.

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Impact of primary aldosteronism on renal function in patients with type 2 diabetes

Cited by 6 publications

References 36 publications

Screening for primary aldosteronism in the diabetic population: a cohort study

Screening for primary aldosteronism in the diabetic population: a cohort study

Characteristics of aldosterone-producing adenomas in patients without plasma renin activity suppression

The Entity of Connshing Syndrome: Primary Aldosteronism with Autonomous Cortisol Secretion

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