Autonomous cortisol secretion in patients with primary aldosteronism: prevalence and implications on cardiometabolic profile and on surgical outcomes

Abstract

Purpose: To evaluate the prevalence of autonomous cortisol secretion (ACS) in patients with primary aldosteronism (PA) and its implications on cardiometabolic and surgical outcomes. Methods: A retrospective multicenter study of PA patients who underwent 1mg-dexamethasone suppression test (DST) during diagnostic work-up in 21 Spanish tertiary hospitals. ACS was defined as a cortisol post-DST >1.8µg/dL (confirmed ACS if >5µg/dL and possible ACS if 1.8-5µg/dL) in absence of specific clinical features of hypercortisolism. The cardiometabolic profile was compared with a control group with ACS without PA (ACS group) matched for age and DST levels. Results: The prevalence of ACS in the global cohort of patients with PA (n=176) was 29% (ACS-PA; n=51). Ten patients had confirmed ACS and 41 possible ACS. The cardiometabolic profile of ACS-PA and PA-only patients was similar, except for older age and larger tumor size of the adrenal lesion in the ACS-PA group. When comparing the ACS-PA group (n=51) and the ACS group (n=78), the prevalence of hypertension (OR 7.7 [2.64-22.32]) and cardiovascular events (OR 5.0 [2.29-11.07]) was higher in ACS-PA patients than in ACS patients. The coexistence of ACS in patients with PA did not affect the surgical outcomes, the proportion of biochemical cure and clinical cure being similar between ACS-PA and PA-only groups. Conclusion: Cortisol and aldosterone secretion affects almost one-third of patients with PA. Its occurrence is more frequent in patients with larger tumors and advanced age. However, the cardiometabolic and surgical outcomes of patients with ACS-PA and PA-only are similar.

Epidemiology and Management of Hypertension and Diabetes Mellitus in Patients with Mild Autonomous Cortisol Secretion: A Review

“…In addition, the coexistence of aldosterone and cortisol hypersecretion has been reported in about 30% of patients with primary aldosteronism ("Connshing syndrome") [31,32]. Patients with cosecretion of aldosterone and cortisol have a higher prevalence of hypertension (odds ratio [OR] 7.7, 95% CI 2.64-22.32) than patients with MACS without primary aldosteronism.…”

Primary aldosteronism 2.0: an update for clinicians on diagnosis and treatment

“…35 In APA patients, cosecretion of cortisol evidenced by the 1 -mg dexamethasone suppression test is common (eg, one -third of patients in a study from Spain), but the implications of this for surgical patient outcomes are unclear at the moment, except for postoperative adrenal insufficiencies (AIs). 90 On the other hand, patients with PA seem not to require routine evaluation for AI if concurrent hypercortisolism has been excluded preoperatively. 91 Several case reports and small cohort studies reported on the successful use of radiofrequency ablation (RFA) for the treatment of unilateral PA. 92 Current evidence comparing RFA with unilateral adrenalectomy for the treatment of PA is limited and variable.…”