Insulin Sensitivity in Patients with Primary Aldosteronism: A Follow-Up Study

Catena, Cristiana; Lapenna, Roberta; Baroselli, Sara; Nadalini, Elisa; Colussi, GianLuca; Novello, Marileda; Favret, G; Melis, Alessandra; Cavarape, Alessandro; Sechi, Leonardo A.

doi:10.1210/jc.2006-0736

Cited by 232 publications

(217 citation statements)

References 30 publications

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“…Our finding that aldosterone's association with glucose metabolism is independent of PRA is consistent with observations made in the pathological state of primary aldosteronism, which is associated with higher levels of insulin resistance 3. The treatment of primary aldosteronism with adrenalectomy or mineralocorticoid receptor antagonism improves insulin sensitivity and insulin secretion 27, 28. The largest pharmacologic diabetes mellitus prevention trials examining RAAS antagonism as a primary end point, the DREAM (Diabetes Reduction Assessment with Ramipril and Rosiglitazone Medication) study and the NAVIGATOR (Nateglinide and Valsartan in Impaired Glucose Tolerance Outcome Research) study, both showed modest reductions in risk of diabetes mellitus with an ACE‐I or ARB, which were significant in NAVIGATOR (14% risk reduction; P <0.0001) 29, 30.…”

Section: Discussionsupporting

confidence: 90%

Renin‐Angiotensin‐Aldosterone System, Glucose Metabolism and Incident Type 2 Diabetes Mellitus: MESA

Joseph

Tcheugui

Effoe

et al. 2018

JAHA

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BackgroundMechanistic studies suggest that aldosterone impairs glucose metabolism. We investigated the cross‐sectional associations of aldosterone and plasma renin activity with fasting plasma glucose, insulin resistance (IR), β‐cell function, and longitudinal association with incident diabetes mellitus among adults in MESA (the multiethnic study of atherosclerosis) prospective cohort study.Methods and ResultsHomeostatic model assessment of IR (HOMA2‐IR) and HOMA2‐β were used to estimate IR and β‐cell function, respectively. Incident diabetes mellitus was defined as fasting plasma glucose ≥126 mg/dL or anti‐diabetic medication use at follow‐up. Linear regression was used to examine cross‐sectional associations of aldosterone with fasting plasma glucose, HOMA2‐IR and HOMA2‐β; Cox regression was used to estimate hazard ratios (HR) for incident diabetes mellitus with multivariable adjustment. There were 116 cases of incident diabetes mellitus over 10.5 years among 1570 adults (44% non‐Hispanic white, 13% Chinese American, 19% Black, 24% Hispanic American, mean age 64±10 years, 51% female). A 100% increase in log‐aldosterone was associated with a 2.6 mg/dL higher fasting plasma glucose, 15% higher HOMA2‐IR and 6% higher HOMA2‐β (P<0.01). A 1‐SD increase in log‐aldosterone was associated with a 44% higher risk of incident diabetes mellitus (P<0.01) with the greatest increase of 142% (P<0.01) observed in Chinese Americans (P for interaction=0.09 versus other ethnicities). Similar cross‐sectional findings for log‐plasma renin activity existed, but log‐plasma renin activity was not associated with incident diabetes mellitus after full adjustment.ConclusionsAldosterone is associated with glucose homeostasis and diabetes mellitus risk with graded associations among Chinese Americans and blacks, suggesting that pleiotropic effects of aldosterone may represent a modifiable mechanism in diabetes mellitus pathogenesis with potential racial/ethnic variation.

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Section: Discussionsupporting

confidence: 90%

Renin‐Angiotensin‐Aldosterone System, Glucose Metabolism and Incident Type 2 Diabetes Mellitus: MESA

Joseph

Tcheugui

Effoe

et al. 2018

JAHA

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“…31 In our study, there were no significant differences in the prevalence of diabetes mellitus, higher plasma glucose levels or use of antidiabetic drugs among all studied groups.…”

Section: Discussioncontrasting

confidence: 47%

The prevalence of metabolic syndrome and its components in two main types of primary aldosteronism

et al. 2010

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Metabolic syndrome (MS) is frequent clinical condition in patients with hypertension. Primary aldosteronism (PA) is a common form of secondary hypertension. This study was aimed at investigating the prevalence of the MS and its components in the two major forms of PA, in unilateral aldosterone-producing adenoma (APA) and bilateral aldosterone overproduction because of idiopathic hyperaldosteronism (IHA). The diagnosis of the particular form of PA was based on adrenal venous sampling and/or successful surgery confirmed by histopathological examination. We analyzed clinical and laboratory data from 100 patients with PA (50 patients with IHA and 50 patients with APA) and from 90 patients with essential hypertension (EH). Metabolic profiles of patients with bilateral form of PA (because of IHA) were similar to EH, but differed from those in patients with unilateral form of PA (APA). The prevalence of the MS (62% in IHA, 34% in APA and 56% in EH), the body mass index value (30 ± 4 kg m -2 in IHA, 27±5 kg m -2 in APA and 29±5 kg m -2 in EH) and triglycerides levels (1.9±0.9 mmol l -1 in IHA,1.4± 0.8 mmol l -1 in APA and 2.01 ± 1.39 mmol l -1 in EH) were all significantly (Po0.05) higher in IHA compared with APA patients. Metabolic profile of patients with bilateral form of PA (because of IHA) is similar to EH in contrast to unilateral form of PA (APA).

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“…We found that treatment with MRAs decreased VAT but not SAT in patients with PA; however, serum lipids and HOMA-IR were not influenced by the medical treatment. Catena et al [31] reported that treatment with surgery or MR antagonists rapidly and persistently restores normal sensitivity to insulin in patients with PA, which was independent of plasma potassium levels. In their report, HOMA-IR was decreased at 6 months after treatment and increased to the baseline levels over an average period of 5.7 years.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with PA have a significantly higher prevalence of metabolic syndrome than those with essential hypertension (EHT) [10,11,12]. The mineralocorticoid receptor (MR) is expressed in the kidneys and in adipose tissue.…”

Section: Introductionmentioning

confidence: 99%

Comparison of eplerenone and spironolactone for the treatment of primary aldosteronism

et al. 2015

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Insulin Sensitivity in Patients with Primary Aldosteronism: A Follow-Up Study

Abstract: Insulin resistance is present in patients with tumoral and idiopathic aldosteronism, but the defect appears less severe than in patients with essential hypertension. Treatment with surgery or aldosterone antagonists restores rapidly and persistently normal sensitivity to insulin.

Cited by 232 publications

References 30 publications

Renin‐Angiotensin‐Aldosterone System, Glucose Metabolism and Incident Type 2 Diabetes Mellitus: MESA

Renin‐Angiotensin‐Aldosterone System, Glucose Metabolism and Incident Type 2 Diabetes Mellitus: MESA

The prevalence of metabolic syndrome and its components in two main types of primary aldosteronism

Comparison of eplerenone and spironolactone for the treatment of primary aldosteronism

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