Obesity as a key factor underlying idiopathic hyperaldosteronism
J Clin Endocrinol Metab. 2018 Aug 24.
Abstract
CONTEXT
Recently, the relationship between primary aldosteronism (PA) and various metabolic disorders including obesity, diabetes mellitus, and dyslipidemia has been discussed. In PA, however, aldosterone-producing adenoma (APA) and idiopathic hyperaldosteronism (IHA) have different etiologies.
OBJECTIVE
Our objectives were to clarify differences in obesity and metabolic disorders between APA and IHA, and to gain new insight in the pathogenesis of IHA.
DESIGN, SETTING, AND PARTICIPANTS
This is a retrospective cross-sectional study. We assessed the PA database established by the multicenter Japan PA study (JPAS). For comparative analysis, data were also collected from 274 essential hypertension (EHT) outpatients.
MAIN OUTCOME MEASURES
We compared prevalences of obesity and metabolic disorders between APA and IHA patients. Comparisons with sex-, age- and blood pressure- matched EHT patients were also performed. Correlations between metabolic parameters and plasma aldosterone concentrations (PACs) in each subtype were analyzed.
RESULTS
Analysis of 516 APA and 1015 IHA patients revealed PACs were significantly higher in APA than IHA patients. By contrast, after adjusting for clinical backgrounds, the prevalence of obesity was significantly higher in IHA than in APA or EHT patients. Although the prevalences of diabetes mellitus and dyslipidemia did not significantly differ between IHA and APA patients, triglyceride and HbA1c were significantly higher in IHA than in APA patients. There was no significant correlation between metabolic parameters and PACs in either subtype.
CONCLUSION
IHA patients tend to be obese despite lower PACs than in APA patients. The present results suggest obesity-related factors contribute to the pathogenesis of IHA.