Higher prevalence of metabolic disorders in patients with bilateral primary aldosteronism than unilateral primary aldosteronism

Zhang, Zhihua; Luo, Qian; Tuersun, Tilakezi; Wang, Guoliang; Wu, Ting; Zhang, Delian; Wang, Menghui; Zhou, Kaihong; Sun, Le; Yue, Na; Li, Nanfang

doi:10.1111/cen.14318

Cited by 11 publications

(20 citation statements)

References 32 publications

(52 reference statements)

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“…The strength of our study is the direct use of CT scans to assess the abdominal component, in particular, the SAT and VAT can be measured directly and quantified using the following indexes, area and ratio. Our approach should be more convincing than other previous studies that use weight, BMI, or WC for assessment (16,17).…”

Section: Discussionmentioning

confidence: 91%

“…Whereas, interesting was that recent studies had indicated that patients with APA had higher risk of developing cardiac events among the PA population (27,28). And despite having lower PAC than patients with APA, only those with IHA are more likely to develop MetS (16,17).…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, patients with APA should theoretically experience severer obesity-related disorders than those with IHA due to aldosterone excess. However, studies have reported that patients with IHA have more metabolic disorders and a higher prevalence of obesity than those with APA (16,17). We accordingly assumed that the distribution and mechanisms of the development of abdominal obesity in the two subtypes of PA should also be different.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of Abdominal Computed Tomography Scans for Differentiating the Discrepancies in Abdominal Adipose Tissue Between Two Major Subtypes of Primary Aldosteronism

et al. 2021

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The aim of this study was to analyze the differences in the distribution of abdominal adipose tissue between the two subtypes of primary aldosteronism (PA) using abdominal computed tomography. We retrospectively analyzed patients diagnosed as having essential hypertension (EH) or PA from the prospectively collected Taiwan Primary Aldosteronism Investigation (TAIPAI) database. Patients with PA were divided into the subgroups of idiopathic hyperaldosteronism (IHA) and unilateral aldosterone-producing adenoma (APA). Patients’ basic clinicodemographic data were collected, and a self-developed CT-based software program was used to quantify the abdominal adiposity indexes, including visceral adipose tissue (VAT) area, VAT ratio, waist circumference (WC), subcutaneous adipose tissue (SAT) area, and SAT ratio. We included 190 patients with EH and 436 patients with PA (238 with IHA and 198 with APA). The APA group had significantly lower abdominal adiposity indexes than the other groups. We also found negative correlations of aldosterone-to-renin ratio (ARR) with VAT area, VAT ratio, WC, and body mass index (BMI) in the APA group. After propensity score matching (which left 184 patients each in the IHA and APA groups), patients in the APA group still had significantly lower WC, SAT area, SAT ratio, and VAT ratio than those in the IHA group. Furthermore, logistic regression analysis indicated that lower probability of abdominal obesity was significantly related to patients with APA. Our data revealed that the distribution of abdominal adipose tissue was similar in patients with IHA and those with EH, but the abdominal adiposity indexes were significantly lower in patients with APA than in those with IHA and EH.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Evaluation of Abdominal Computed Tomography Scans for Differentiating the Discrepancies in Abdominal Adipose Tissue Between Two Major Subtypes of Primary Aldosteronism

et al. 2021

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“…Metabolic syndrome (MetS) is a frequent clinical condition in hypertensive patients especially in PA patients ( 33 ). In addition, APA and IHA may have different mechanisms to cause Mets ( 34 ). In general, aldosterone excess is often present in obesity and is closely associated with visceral adipose tissue, suggesting its involvement in the pathogenesis of obesity-related hypertension ( 35 ).…”

Section: Discussionmentioning

confidence: 99%

“…However, obesity-associated PVAT leads to a change in the profile of the released adipocytokines, resulting in a decreased vasorelaxing effect. It has been reported that obesity-related factors may contribute to the pathogenesis of IHA ( 34 ). Since obesity results in an imbalance between endothelium-derived vasoactive factors favoring vasoconstriction, we expected that positive relationship between FMD and BMI is found in IHA group, as opposed to APA group.…”

Section: Discussionmentioning

confidence: 99%

Clinical impacts of endothelium-dependent flow-mediated vasodilation assessment on primary aldosteronism

Watanabe

Morimoto

Morishima

et al. 2021

Endocrine Connections

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Objective: Primary aldosteronism (PA) is divided into two major subtypes, aldosterone-producing adenoma (APA) and bilateral idiopathic hyperplasia (IHA), and is associated with a higher risk of cardiovascular events. However, the nature of vascular function in PA patients remains to be determined. The aim of this study was to determine vascular function and investigate the implications of vascular function assessments in these patients. Methods: Flow-mediated dilation (FMD), as an index of endothelial function, and cardio-ankle vascular index (CAVI), as an index of arterial stiffness, were retrospectively compared between 42 patients with APA, 37 patients with IHA, and 42 patients with essential hypertension (EH). These values were also compared with background factors, KCNJ5 mutation and clinical outcome in terms of blood pressure reduction after adrenalectomy in the APA group. Results: FMD was significantly lower in the APA group (4.8±2.1%) and IHA group (4.1±1.9%) than in the EH group (5.7±2.1%). CAVI did not differ significantly among groups. Although no significant correlations were seen between FMD and background factors in the IHA group, FMD correlated negatively with body mass index and plasma aldosterone concentration in the APA group (rs=-0.313, rs=-0.342, respectively). KCNJ5 mutational status was not associated with FMD value. High FMD was associated with blood pressure normalization after adrenalectomy in the APA group. Conclusions: Patients with PA displayed impaired endothelial function. Complete clinical success after adrenalectomy was associated with preserved endothelial function. This study provides a better understanding of FMD assessment in patients with PA.

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Is adrenal venous sampling always necessary to differentiate between unilateral and bilateral primary aldosteronism? Lesson from the SPAIN-ALDO register

Parra Ramírez,

Martín Rojas-Marcos,

Paja Fano

et al. 2023

Endocrine

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Purpose: To evaluate whether the clinical, biochemical and radiological features of patients with primary aldosteronism (PA) can predict both main subtypes of PA.Methods: A retrospective multicenter study of PA patients followed in 27 Spanish tertiary hospitals (SPAIN-ALDO Register). Only patients with con rmed unilateral or bilateral PA based on adrenal venous sampling (AVS) and/or postsurgical biochemical cure after adrenalectomy were included. Supervised regression techniques were used for model development.Results: 328 patients [270 unilateral PA (UPA), 58 bilateral PA (BPA)] were included. The area under the curve (AUC) for aldosterone/potassium ratio and aldosterone responses following saline infusion test were 0.602 [95%CI 0.520 to 0.684] and 0.574 [95% CI 0.446-0.701], respectively, to differentiate UPA from BPA. The AUC was 0.825 [95% 0.764-0.886] when the prediction model with seven parameters -comorbidities (dyslipidemia, cerebrovascular disease, SAS), SBP, plasma aldosterone levels (PAC), hypokalemia and unilateral adrenal nodule >1 cm and normal contralateral adrenal gland on CT/MRI -was used. In patients without comorbidities, hypokalemia, SBP >160 mmHg, PAC >40 ng/dL, and unilateral adrenal lesions were associated with a likelihood of having a UPA of 98.5%. The chance of BPA was higher in individuals with comorbidities, SBP <140 mmHg, normokalemia, low PAC levels, and no adrenal tumors on the CT/MRI (91.5%).Conclusion: A combination of high PAC, SBP >160 mmHg, low serum potassium, a unilateral adrenal nodule and no comorbidities could predict a UPA with a 98.5% accuracy.

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Higher prevalence of metabolic disorders in patients with bilateral primary aldosteronism than unilateral primary aldosteronism

Cited by 11 publications

References 32 publications

Evaluation of Abdominal Computed Tomography Scans for Differentiating the Discrepancies in Abdominal Adipose Tissue Between Two Major Subtypes of Primary Aldosteronism

Evaluation of Abdominal Computed Tomography Scans for Differentiating the Discrepancies in Abdominal Adipose Tissue Between Two Major Subtypes of Primary Aldosteronism

Clinical impacts of endothelium-dependent flow-mediated vasodilation assessment on primary aldosteronism

Is adrenal venous sampling always necessary to differentiate between unilateral and bilateral primary aldosteronism? Lesson from the SPAIN-ALDO register

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