Abstract: FR-PO572

The Change of Glucose Metabolism in Primary Aldosteronism after Target Treatment

Session Information

Category: Hypertension

  • 1106 Hypertension: Clinical and Translational - Secondary Causes

Authors

  • Lin, Yu-Fang, National Taiwan University Hospital, Taipei city, Taiwan
  • Wu, Vincent, National Taiwan University Hospital, Taipei city, Taiwan
  • Wu, Kwan-dun, National Taiwan University Hospital, Taipei city, Taiwan
Background

Discrepant data have been published on the effects of aldosterone excess on abnormal glucose metabolism. There is no consistent result of follow-up glucose metabolism after adrenalectomy or spironolactone in patients with primary aldosteronism (PA).

Methods

Patients were enrolled during the screening test after adequate substitutive drug periods. Aldosterone, ARR(aldosterone renin ratio), glucose metabolism parameters including HOMA-IR and HOMA-β were checked and calculated before and 1 year after on-target treatment.

Results

One hundred and thirty-eight PA patients were enrolled (mean age 50.6±11.5, 49% female), among them 72 patients with aldosterone producing adenoma (APA) received adrenalectomy (Group 1), 33 idiopathic hyperaldosteronism (IHA) treated with spironolactone (Group 2) and 33 APA treated with spironolactone (Group 3). There was no change of fasting glucose before and after treatment (P=0.056, 0.497, 0.575). Fasting insulin increased in group 1 and group 2 (P=0.019, 0007). Aldosterone decreased after adrenalectomy but increased after IHA treated with spironolactone. HOMA-β improved in patients in the former two groups (P=0.000, 0.015). HOMA-IR deteriorated significantly in group 2 (P=0.019) but not in group 1(P=0.109). The fasting glucose, fasting insulin, HOMA-IR and HOMA-β remained unchanged in group 3. At enrollment, APA had higher HOMA-IR (P=0.000) and fasting plasma glucose(P=0.019) than IHA . There was a negative correlation between aldosterone and HOMA-β or HOMA-IR after adjustment with serum potassium level, SBP, BMI, age, and sex.

Conclusion

At enrollment, APA had higher HOMA-IR and fasting plasma glucose than IHA. HOMA-β could improve in APA treated with adrenalectomy and IHA received spironolactone. HOMA-IR deteriorated in IHA patients but remained unchanged in other two groups. Thus, adrenalectomy of APA could improve glucose homeostasis other than spironolactone in APA.

Glucose metabolism parameters in APA and IHA at baselines and at follow-up
 Group 1: APA adrenalectomy (n=72)Group 2: IHA spironolactone (n=33)Group 3: APA spironolactone (n=33)
 BaselineFollow-uppBaselineFollow-uppBaselineFollow-upp
Plasma glucose(mg/dl)100.1±22.5
95±12.7
0.05694.8±12.397.4±190.497
108.1±28.7
106.2±40.5
0.575
Insulin (uU/ml)10.5±8.9
13.5±10.3
0.019*
8.8±5.212.2±7.7
0.007*
16.1±36
13.4±12.6
0.669
HOMA IR2.7±2.4
3.3±2.80.109
2.2±1.5
3±2
0.019*
4.3±8.4
3.8±4.4
0.748
HOMA-1.1±1
1.6±1.10.000*
1±0.6
1.4±1
0.015*
1.6±4.3
1.3±1.5
0.743

*p<0.05

Funding

  • Government Support - Non-U.S.