Youichi Ohno1, Masakatsu Sone1, Nobuya Inagaki1, Toshinari Yamasaki2, Osamu Ogawa2, Yoshiyu Takeda3, Isao Kurihara4, Hironobu Umakoshi5, Takamasa Ichijo6, Takuyuki Katabami7, Norio Wada8, Yoshihiro Ogawa9, Takanobu Yoshimoto10, Junji Kawashima11, Minemori Watanabe12, Yuichi Matsuda13, Hiroki Kobayashi14, Hirotaka Shibata15, Shozo Miyauchi16, Kohei Kamemura17, Tomikazu Fukuoka18, Koichi Yamamoto19, Michio Otsuki20, Tomoko Suzuki21, Mitsuhide Naruse5. 1. Department of Diabetes, Endocrinology and Nutrition, Kyoto University, Kyoto, Japan. 2. Department of Urology, Kyoto University, Kyoto, Japan. 3. Department of Internal Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan. 4. Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Tokyo, Japan. 5. Department of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Kyoto, Japan. 6. Department of Endocrinology and Metabolism, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan. 7. Division of Metabolism and Endocrinology, Department of Internal Medicine, St. Marianna University School of Medicine Yokohama City Seibu Hospital, Yokohama, Japan. 8. Department of Diabetes and Endocrinology, Sapporo City General Hospital, Sapporo, Japan. 9. Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. 10. Department of Molecular Endocrinology and Metabolism, Tokyo Medical and Dental University, Tokyo, Japan. 11. Department of Metabolic Medicine, Faculty of Life Science, Kumamoto University, Kumamoto, Japan. 12. Department of Endocrinology and Diabetes, Okazaki City Hospital, Okazaki, Japan. 13. Department of Cardiology, Sanda City Hospital, Sanda, Japan. 14. Division of Nephrology, Hypertension and Endocrinology, Nihon University School of Medicine, Tokyo, Japan. 15. Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Yufu, Japan. 16. Department of Internal Medicine, Uwajima City Hospital, Uwajima, Japan. 17. Department of Cardiology, Akashi Medical Center, Akashi, Japan. 18. Department of Internal Medicine, Matsuyama Red Cross Hospital, Matsuyama, Japan. 19. Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka, Japan. 20. Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka, Japan. 21. Department of Public Health, School of Medicine, International University of Health and Welfare, Narita, Japan.
Abstract
Context: Recently, the relationship between primary aldosteronism (PA) and various metabolic disorders, including obesity, diabetes mellitus, and dyslipidemia, has been discussed. However, in PA, 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 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 Primary Aldosteronism Study. For comparative analysis, data were also collected from 274 patients with essential hypertension (EHT). Main Outcome Measures: We compared prevalences of obesity and metabolic disorders between patients with APA and patients with IHA. Comparisons with sex-, age-, and blood pressure-matched patients with EHT were also performed. Correlations between metabolic parameters and plasma aldosterone concentrations (PACs) in each subtype were analyzed. Results: Analysis of 516 patients with APA and 1015 patients with IHA revealed PACs were significantly higher in patients with APA than patients with IHA. By contrast, after we adjusted for clinical backgrounds, the prevalence of obesity was significantly higher in patients with IHA than in patients with APA or EHT. Although the prevalences of diabetes mellitus and dyslipidemia did not significantly differ between patients with IHA and patients with APA, triglyceride and HbA1c were significantly higher in patients with IHA than in patients with APA. There was no significant correlation between metabolic parameters and PACs in either subtype. Conclusions: Patients with IHA tend to be obese despite lower PACs than in patients with APA. The present results suggest that obesity-related factors contribute to the pathogenesis of IHA.
Context: Recently, the relationship between primary aldosteronism (PA) and various metabolic disorders, including obesity, diabetes mellitus, and dyslipidemia, has been discussed. However, in PA, 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 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 Primary Aldosteronism Study. For comparative analysis, data were also collected from 274 patients with essential hypertension (EHT). Main Outcome Measures: We compared prevalences of obesity and metabolic disorders between patients with APA and patients with IHA. Comparisons with sex-, age-, and blood pressure-matched patients with EHT were also performed. Correlations between metabolic parameters and plasma aldosterone concentrations (PACs) in each subtype were analyzed. Results: Analysis of 516 patients with APA and 1015 patients with IHA revealed PACs were significantly higher in patients with APA than patients with IHA. By contrast, after we adjusted for clinical backgrounds, the prevalence of obesity was significantly higher in patients with IHA than in patients with APA or EHT. Although the prevalences of diabetes mellitus and dyslipidemia did not significantly differ between patients with IHA and patients with APA, triglyceride and HbA1c were significantly higher in patients with IHA than in patients with APA. There was no significant correlation between metabolic parameters and PACs in either subtype. Conclusions: Patients with IHA tend to be obese despite lower PACs than in patients with APA. The present results suggest that obesity-related factors contribute to the pathogenesis of IHA.