Sex Differences in Clinical Manifestations and Serum CXCR4/CXCL12 Levels in Patients with Type 2 Diabetes and Primary Aldosteronism

Abstract

Type 2 diabetes mellitus (T2DM) and hypertension are prevalent chronic diseases in modern society. Primary hyperaldosteronism (PA) is the most common cause of secondary hypertension. Our study examined the clinical characteristics of T2DM patients afflicted with PA. We enrolled a total of 213 T2DM patients with hypertension and observed a 22.1% prevalence of PA within this group. Sex disparities in clinical presentations were observed. Among male PA patients, the incidence of obesity significantly exceeded that of the essential hypertension (EH) group (40% vs. 4.5%, χ2 = 4.172, p = 0.041), with the plasma aldosterone concentration (PAC) demonstrating a positive correlation with body mass index (BMI) (correlation coefficient = 0.318, p = 0.001). In contrast, among female PA patients, the prevalence of proteinuria was notably greater than that in the EH group (54.5% vs. 24.7%, p < 0.05), and the PAC was positively correlated with proteinuria (correlation coefficient = 0.213, p = 0.032). Significant sex differences emerged in the serum concentrations of brain natriuretic peptide (BNP), atrial natriuretic peptide (ANP), C-X-C motif chemokine receptor 4 (CXCR4), C-X-C motif chemokine ligand 12 (CXCL12), adiponectin, and leptin. The serum levels of BNP, ANP, CXCR4, CXCL12, and leptin were significantly correlated with BMI. In female patients, the PAC was significantly positively correlated with CXCR4 (correlation coefficient = 0.322, p = 0.004) and CXCL12 (correlation coefficient = 0.248, p = 0.029). Our findings highlight sex-specific differences in the clinical manifestations of T2DM patients with PA. Notably, the serum BNP, ANP, leptin, adiponectin, CXCR4, and CXCL12 levels exhibited significant sex differences and correlated significantly with BMI. In female patients, the PAC was positively correlated with CXCR4 and CXCL12 levels.