Recovery from diabetes mellitus in primary aldosteronism patients after adrenalectomy

Liu, Yu; Lin, Lede; Yuan, Cheng; Shen, Shunyao; Tang, Yin; Liu, Zhihong; Zhu, Ye; Zhou, Liang

doi:10.1186/s12902-022-01254-6

Cited by 2 publications

(1 citation statement)

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“…Screening protocols (aldosterone-to-renin ratio) are recommended for a selective subgroup, e.g., in cases with standard therapy-resistant hypertension, high blood and hypokalemia, hypertension onset at <40 years, people with a family history of hypertension or stroke at a young age, atrial fibrillation, and incidental adenoma. After a positive screening test, confirmatory tests such as the fludrocortisone suppression test, oral sodium loading test, saline infusion test, and captopril challenge test are required depending on the patient [12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Cross-Disciplinary Approach of Adrenal Tumors: Insights into Primary Aldosteronism-Related Mineral Metabolism Status and Osteoporotic Fracture Risk

Trandafir,

Gheorghe,

Sima

et al. 2023

IJMS

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Our objective was to overview the novel aspects in the field of adrenal gland neoplasms, namely, the management of bone status with respect to primary aldosteronism (PA). In the current narrative review, a PubMed study was conducted from inception until June 2023. The inclusion criteria were: human (clinically relevant) studies of any study design (at least 10 patients per study); English papers; and the following combination of key words within the title and/or abstract: “aldosterone” AND “bone”, “skeleton”, “osteoporosis”, “fracture”, “calcium”, “parathyroid”, “DXA”, “osteocalcin”, “P1NP”, “alkaline phosphatase”, “bone marker”, “trabecular bone score”, or “FRAX”. The exclusion criteria were in vitro or animal studies, reviews, and case reports/series. We screened 1027 articles and finally included 23 studies (13 of case-control type, 3 cross-sectional, 5 prospective, 1 observational cohort, and 1 retrospective study). The assessments provided in these studies were as follows: nine studies addressed Dual-Energy X-ray Absorptiometry (DXA), another study pointed out a bone microarchitecture evaluation underlying trabecular bone score (TBS), and seven studies investigated the bone turnover markers (BTMs) profile. Moreover, 14 studies followed the subjects after adrenalectomy versus medical treatment, and 21 studies addressed secondary hyperparathyroidism in PA patients. According to our study on published data during a period of almost 40 years (n = 23, N = 3965 subjects aged between 38 and 64, with a mean age 56.75, and a female-to-male ratio of 1.05), a higher PTH in PA versus controls (healthy persons or subjects with essential hypertension) is expected, secondary hyperparathyroidism being associated in almost half of the adults diagnosed with PA. Additionally, mineral metabolism anomalies in PA may include lower serum calcium and higher urinary calcium output, all these three parameters being reversible under specific therapy for PA, regardless medical or surgical. The PA subgroup with high PTH seems at higher cardiovascular risk, while unilateral rather than bilateral disease was prone to this PTH anomaly. Moreover, bone mineral density (BMD) according to central DXA might show a higher fracture risk only in certain adults, TBS being a promising alternative (with a still unknown perspective of diabetes’ influence on DXA-TBS results in PA). However, an overall increased fracture prevalence in PA is described in most studies, especially with respect to the vertebral site, the fracture risk that seems correctable upon aldosterone excess remission. These data recommend PA as a cause of secondary osteoporosis, a treatable one via PA intervention. There is still an area of debate the way to address BMTs profile in PA, the case’s selection toward specific bone evaluation in every day practice, and further on, the understanding of the potential genetic influence at the level of bone and mineral complications in PA patients.

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Section: Introductionmentioning

confidence: 99%