VIN-CENT WUCHIEH-KAI CHANWAN-CHEN WUPeng, Kang-YungKang-YungPengChang, Yuan-ShianYuan-ShianChangYeh, Fang-YuFang-YuYehJIUN-YANG CHIANGYUAN-JU LEEKAO-LANG LIUSHUO-MENG WANGYEN-HUNG LINSHIH-CHIEH CHUEHTAI-SHUAN LAISHAO-YU YANGCHIN-CHEN CHANGLee, Bo-ChiagBo-ChiagLeeKUO-HOW HUANGPO-CHIH LINLIAN-YU LINSHIH-CHENG LIAORUOH-FANG YENCHING-CHU LUEr, Leay-KiawLeay-KiawErHu, Ya-HuiYa-HuiHuChang, Chia-HuiChia-HuiChangWu, Che-HsiungChe-HsiungWuTsai, Yao-ChouYao-ChouTsaiHo, Chen-HsunChen-HsunHoHuang, Wei-ChiehWei-ChiehHuangChen, Ying-YingYing-YingChen2022-12-202022-12-202023-0209169636https://scholars.lib.ntu.edu.tw/handle/123456789/626626Concurrent 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.enAutonomous cortisol secretion; Incident; New-onset diabetes; Primary aldosteronism; TAIPAI[SDGs]SDG3journal article10.1038/s41440-022-01086-w364819672-s2.0-85143838685