Metabolic syndrome and primary aldosteronism: time for reappraisal?

Abstract

Recent studies have addressed the issue of an association of metabolic abnormalities with primary aldosteronism (PA). In a prospective study, we were the first to report a higher prevalence of metabolic syndrome, as defined by Adult Panel Treatment (ATP) III criteria, in a large population of patients with PA compared with patients with essential hypertension (EH) (41 vs 29%, Po0.05). 1 Distribution of each component of the metabolic syndrome showed a higher frequency of hyperglycaemia in PA than in EH, whereas there was no difference between the two populations as to blood pressure levels, abdominal obesity, body mass index and lipid levels. The occurrence of metabolic syndrome was similar in aldosterone-producing adenoma (APA) and idiopathic hyperaldosteronism (IHA) subtypes. Ronconi et al. 2 confirmed a higher prevalence of the metabolic syndrome in PA compared with matched EH patients (45 vs 30%, Po0.05). Among their PA patients, the metabolic syndrome tended to be more frequent, though not significantly, in IHA than in APA (51 vs 32%). In the same line, Iacobellis et al. 3 have recently found, using the 2004 modified version of ATP III (high fasting glucose X100 mg per 100 ml), that PA was associated with metabolic syndrome more frequently than EH, and when PA subgroups were considered separately the metabolic syndrome was slightly prevalent in APA compared with IHA (29 vs 21%). The clinical relevance of all these observations is that aldosterone excess may lead to cardiovascular damage by mechanisms independent of its hypertensive effect, that is, an altered metabolic profile, suggesting that the reported higher rate of cardiovascular events in PA than in EH might be due to increased prevalence of the metabolic syndrome in the former condition. 4 However, the pathophysiology and characteristics of this association are still controversial and not fully elucidated.In this issue of the Journal of Human Hypertension, Somloova et al. 5 provide additional fuel to this matter with data on the metabolic phenotype of patients with PA, particularly as to the intriguing differences between the two main subtypes. The authors analysed retrospectively 100 patients with PA, 50 IHA and 50 APA, in comparison with 90 patients with EH matched for age and duration of hypertension. According to the 2009 International Diabetes Federation definition of the metabolic syndrome, its prevalence was similar in patients with PA and EH. Within PA and analysing metabolic syndrome individual components, fasting glucose level was similar in IHA and APA, whereas highdensity lipoprotein-cholesterol was markedly lower and body mass index and triglycerides were significantly higher in IHA than in APA. Overall, the metabolic syndrome was more prevalent in IHA than in APA (62 vs 36%, Po0.05). The results of Somloova et al. are partly in accordance with those of Matrozova et al. 6 who reported in a large controlled cross-sectional study that prevalence of carbohydrate and lipid metabolism disorders is similar in PA and in EH. However, Matrozova ...

Characteristics and features of clinical manifestations of primary hyperaldosteronism (literature review)

“…Later studies, conducted by V. Ronconi et al (2010), confirmed the higher prevalence of metabolic syndrome in patients with PHA compared to the corresponding patients with EH (45% vs. 30%, p < 0.05) (43,44). In patients with PHA, metabolic syndrome tended to develop more frequently than in patients with EH (51% vs. 32%, p < 0.05).…”