The prevalence of metabolic syndrome and its components in two main types of primary aldosteronism

Abstract

Metabolic syndrome (MS) is frequent clinical condition in patients with hypertension. Primary aldosteronism (PA) is a common form of secondary hypertension. This study was aimed at investigating the prevalence of the MS and its components in the two major forms of PA, in unilateral aldosterone-producing adenoma (APA) and bilateral aldosterone overproduction because of idiopathic hyperaldosteronism (IHA). The diagnosis of the particular form of PA was based on adrenal venous sampling and/or successful surgery confirmed by histopathological examination. We analyzed clinical and laboratory data from 100 patients with PA (50 patients with IHA and 50 patients with APA) and from 90 patients with essential hypertension (EH). Metabolic profiles of patients with bilateral form of PA (because of IHA) were similar to EH, but differed from those in patients with unilateral form of PA (APA). The prevalence of the MS (62% in IHA, 34% in APA and 56% in EH), the body mass index value (30 ± 4 kg m -2 in IHA, 27±5 kg m -2 in APA and 29±5 kg m -2 in EH) and triglycerides levels (1.9±0.9 mmol l -1 in IHA,1.4± 0.8 mmol l -1 in APA and 2.01 ± 1.39 mmol l -1 in EH) were all significantly (Po0.05) higher in IHA compared with APA patients. Metabolic profile of patients with bilateral form of PA (because of IHA) is similar to EH in contrast to unilateral form of PA (APA).

Metabolic syndrome and primary aldosteronism: time for reappraisal?

“…As to comparison between PA and EH, sample selection from populations living in different geographical areas, use of different diagnostic criteria and confirmation procedures for PA, differences in matching and statistical methods, heterogeneity of medications and/or potassium supplementations given to patients during their evaluation, are all aspects to be considered. In addition, the lack of difference in glucose levels between PA and EH patients observed in some studies 5,6 does not exclude a role of aldosterone elevation in altering glucose metabolism. In fact insulin sensitivity, as measured by either the formula of homoeostasis model assessment index or by hyperinsulinemic euglycemic clamps, has been found to be lower in PA than in EH patients and in normotensive subjects.…”

“…9,10 The results of a recent pilot study also suggest that fatty liver, a feature strictly linked to insulin resistance, is a frequent finding in patients with PA, more markedly in those with hypokalemia. 11 The worse metabolic profile described by Somloova et al 5 in IHA than in APA is more difficult to interpret. The fact that overweight/ obesity was more represented in their IHA compared with APA patients needs to be discussed.…”

“…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.…”

SFE/SFHTA/AFCE consensus on primary aldosteronism, part 6: Adrenal surgery

“…The clinical studies, however, demonstrate neither increased prevalence of lipid or glucose metabolism disorder nor improvement with PA-specific treatment [36][37][38].…”

Outcomes of Drug-Based and Surgical Treatments for Primary Aldosteronism

“…57,58 However, PA patients have the same likelihood of clinically defined glucose and lipid metabolism disorders at diagnosis as similar patients with essential hypertension, and adrenalectomy does not improve their clinical metabolic profile. 37,59,60 One study suggests that the subjective well being of patients with unilateral PA, which is lower at baseline than that of the general population, significantly improves after adrenalectomy. 61 …”