https://scholars.lib.ntu.edu.tw/handle/123456789/626626
標題: | New-onset diabetes mellitus risk associated with concurrent autonomous cortisol secretion in patients with primary aldosteronism | 作者: | VIN-CENT WU CHIEH-KAI CHAN WAN-CHEN WU Peng, Kang-Yung Chang, Yuan-Shian Yeh, Fang-Yu JIUN-YANG CHIANG YUAN-JU LEE KAO-LANG LIU SHUO-MENG WANG YEN-HUNG LIN SHIH-CHIEH CHUEH TAI-SHUAN LAI SHAO-YU YANG CHIN-CHEN CHANG Lee, Bo-Chiag KUO-HOW HUANG PO-CHIH LIN LIAN-YU LIN SHIH-CHENG LIAO RUOH-FANG YEN CHING-CHU LU Er, Leay-Kiaw Hu, Ya-Hui Chang, Chia-Hui Wu, Che-Hsiung Tsai, Yao-Chou Ho, Chen-Hsun Huang, Wei-Chieh Chen, Ying-Ying |
關鍵字: | Autonomous cortisol secretion; Incident; New-onset diabetes; Primary aldosteronism; TAIPAI | 公開日期: | 二月-2023 | 來源出版物: | Hypertension research : official journal of the Japanese Society of Hypertension | 摘要: | 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. |
URI: | https://scholars.lib.ntu.edu.tw/handle/123456789/626626 | ISSN: | 09169636 | DOI: | 10.1038/s41440-022-01086-w |
顯示於: | 醫學系 |
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