New-onset diabetes mellitus risk associated with concurrent autonomous cortisol secretion in patients with primary aldosteronism

• Published in: Hypertension research 2023-02, Vol.46 (2), p.445-455
• Main Authors: Wu, Vin-Cent, Chan, Chieh-Kai, Wu, Wan-Chen, Peng, Kang-Yung, Chang, Yuan-Shian, Yeh, Fang-Yu, Chiang, Jiun-Yang, Lee, Yuan-Ju, Liu, Kao-Lang, Wang, Shuo-Meng, Lin, Yen-Hung, Chueh, Jeff S
• Format: Article
• Language: English
• Subjects: Aldosterone; Diabetes; Diabetes Mellitus, Type 2 - complications; Endocrine disorders; Female; Hormones; Humans; Hydrocortisone; Hyperaldosteronism; Hypertension; Male; Middle Aged; Pathogenesis; Risk Factors
• ISSN: 0916-9636; 1348-4214
• DOI: 10.1038/s41440-022-01086-w

Concurrent autonomous cortisol secretion (ACS) in patients with primary aldosteronism (PA patients) is not uncommon. This work aimed to determine the effect of cortisol levels on incident new-onset type 2 diabetes mellitus (NODM) in PA patients. Using the prospectively designed observational TAIPAI cohort, the PA patients were grouped by cortisol level after an overnight low-dose dexamethasone suppression test (1-mg DST). Of the 476 PA patients, 387 (43.7% men; mean age 52.8 years) did not have baseline DM. After a mean follow-up of 4.3 ± 2.9 years, 32 patients (8.3%) developed NODM. The cutoff value obtained via a generalized additive model showed that a serum cortisol level ≥ 2.65 µg/dL after 1-mg DST was a risk factor for developing NODM (HR, 3.5, p = 0.031) by Cox proportional- hazards model.. In PA patients with a higher body mass index (>25 kg/m ; HR, 3.16), lower estimated glomerular filtration rate (7 years; HR, 3.34), and higher waist-to-hip ratio (>0.9; HR, 3.07), a concomitant cortisol level ≥ 2.65 μg/dL after 1-mg DST were more likely to develop NODM. The high-cortisol group of patients with aldosterone-producing adenoma (APA) using mineralocorticoid receptor antagonist (MRA) was associated with an increased risk of NODM (HR, 5.72). Our results showed that PA patients with a concomitant cortisol level ≥ 2.65 µg/dL after 1-mg DST, independent of the aldosterone level, had a higher incidence of NODM. Such PA patients should be carefully evaluated and managed to achieve better glucose control and prevent metabolic syndrome.