New-onset diabetes mellitus risk associated with concurrent autonomous cortisol secretion in patients with primary aldosteronism
Journal
Hypertension research : official journal of the Japanese Society of Hypertension
Journal Volume
46
Journal Issue
2
Pages
445–455
Date Issued
2023-02
Author(s)
Peng, Kang-Yung
Chang, Yuan-Shian
Yeh, Fang-Yu
Lee, Bo-Chiag
PO-CHIH LIN
Er, Leay-Kiaw
Hu, Ya-Hui
Chang, Chia-Hui
Wu, Che-Hsiung
Tsai, Yao-Chou
Ho, Chen-Hsun
Huang, Wei-Chieh
Chen, Ying-Ying
Abstract
Concurrent autonomous cortisol secretion (ACS) in patients with primary aldosteronism (PA patients) is not uncommon. This work aimed to determine the effect of cortisol levels on incident new-onset type 2 diabetes mellitus (NODM) in PA patients. Using the prospectively designed observational TAIPAI cohort, the PA patients were grouped by cortisol level after an overnight low-dose dexamethasone suppression test (1-mg DST). Of the 476 PA patients, 387 (43.7% men; mean age 52.8 years) did not have baseline DM. After a mean follow-up of 4.3 ± 2.9 years, 32 patients (8.3%) developed NODM. The cutoff value obtained via a generalized additive model showed that a serum cortisol level ≥ 2.65 µg/dL after 1-mg DST was a risk factor for developing NODM (HR, 3.5, p = 0.031) by Cox proportional- hazards model.. In PA patients with a higher body mass index (>25 kg/m2; HR, 3.16), lower estimated glomerular filtration rate (<90 ml/min/1.73 m2; HR, 3.18), longer hypertension duration (>7 years; HR, 3.34), and higher waist-to-hip ratio (>0.9; HR, 3.07), a concomitant cortisol level ≥ 2.65 μg/dL after 1-mg DST were more likely to develop NODM. The high-cortisol group of patients with aldosterone-producing adenoma (APA) using mineralocorticoid receptor antagonist (MRA) was associated with an increased risk of NODM (HR, 5.72). Our results showed that PA patients with a concomitant cortisol level ≥ 2.65 µg/dL after 1-mg DST, independent of the aldosterone level, had a higher incidence of NODM. Such PA patients should be carefully evaluated and managed to achieve better glucose control and prevent metabolic syndrome.
Subjects
Autonomous cortisol secretion; Incident; New-onset diabetes; Primary aldosteronism; TAIPAI
SDGs
Type
journal article