Yuko Akehi1,2, Toshihiko Yanase3, Ryoko Motonaga1, Hironobu Umakoshi4, Mika Tsuiki4, Yoshiyu Takeda5, Takashi Yoneda5, Isao Kurihara6, Hiroshi Itoh6, Takuyuki Katabami7, Takamasa Ichijo8, Norio Wada9, Yui Shibayama9, Takanobu Yoshimoto10, Kenji Ashida11, Yoshihiro Ogawa11, Junji Kawashima12, Masakatsu Sone13, Nobuya Inagaki13, Katsutoshi Takahashi14,15, Megumi Fujita15, Minemori Watanabe16, Yuichi Matsuda17, Hiroki Kobayashi18, Hirotaka Shibata19, Kohei Kamemura20, Michio Otsuki21, Yuichi Fujii22, Koichi Yamamoto23, Atsushi Ogo24, Shintaro Okamura25, Shozo Miyauchi26, Tomikazu Fukuoka27, Shoichiro Izawa28, Shigeatsu Hashimoto29, Masanobu Yamada30, Yuichiro Yoshikawa31, Tatsuya Kai32, Tomoko Suzuki33, Takashi Kawamura34, Mitsuhide Naruse4. 1. Department of Endocrinology and Diabetes Mellitus, Faculty of Medicine, Fukuoka University, Fukuoka, Japan. 2. Diabetes Therapeutics and Research Center, Institute of Advanced Medical Sciences, Tokushima University, Tokushima, Japan. 3. Department of Endocrinology and Diabetes Mellitus, Faculty of Medicine, Fukuoka University, Fukuoka, Japan tyanase@fukuoka-u.ac.jp. 4. Department of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Kyoto, Japan. 5. Department of Internal Medicine, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan. 6. Department of Endocrinology, Metabolism, and Nephrology, School of Medicine, Keio University, Tokyo, 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 Endocrinology and Metabolism, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan. 9. Department of Diabetes and Endocrinology, Sapporo City General Hospital, Sapporo, Japan. 10. Department of Molecular Endocrinology and Metabolism, Tokyo Medical and Dental University, Tokyo, Japan. 11. Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. 12. Department of Metabolic Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan. 13. Department of Diabetes, Endocrinology, and Nutrition, Kyoto University, Kyoto, Japan. 14. Division of Metabolism, Showa General Hospital, Tokyo, Japan. 15. Department of Nephrology and Endocrinology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan. 16. Department of Endocrinology and Diabetes, Okazaki City Hospital, Okazaki, Japan. 17. Department of Cardiology, Sanda City Hospital, Sanda, Japan. 18. Division of Nephrology, Hypertension, and Endocrinology, Nihon University School of Medicine, Tokyo, Japan. 19. Department of Endocrinology, Metabolism, Rheumatology, and Nephrology, Faculty of Medicine, Oita University, Yufu, Japan. 20. Department of Cardiology, Shinko Hospital, Kobe, Japan. 21. Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka, Japan. 22. Department of Cardiology, JR Hiroshima Hospital, Hiroshima, Japan. 23. Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka, Japan. 24. Clinical Research Institute, National Hospital Organization Kyusyu Medical Center, Fukuoka, Japan. 25. Department of Endocrinology, Tenri Yorozu Hospital, Tenri, Japan. 26. Department of Internal Medicine, Uwajima City Hospital, Uwajima, Japan. 27. Department of Internal Medicine, Matsuyama Red Cross Hospital, Matsuyama, Japan. 28. Department of Endocrinology and Metabolism, Tottori University Hospital, Tottori, Japan. 29. Division of Nephrology, Hypertension, Endocrinology, and Diabetology/Metabolism, Fukushima Medical University Hospital, Fukushima, Japan. 30. Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi, Japan. 31. Department of Endocrinology and Diabetes Mellitus, Misato Kenwa Hospital, Misato, Japan. 32. Department of Cardiology, Saiseikai Tondabayashi Hospital, Tondabayashi, Japan. 33. Department of Public Health, School of Medicine, International University of Health and Welfare, Narita, Japan. 34. Kyoto University Health Service, Kyoto, Japan.
Abstract
OBJECTIVE: To investigate the prevalence and causes of diabetes in patients with primary aldosteronism (PA) in a multi-institutional cohort study in Japan. RESEARCH DESIGN AND METHODS: The prevalence of diabetes was determined in 2,210 patients with PA (diagnosed or glycated hemoglobin [HbA1c] ≥6.5% [≥48 mmol/mol]; NGSP) and compared with that of the Japanese general population according to age and sex. In 1,386 patients with PA and clear laterality (unilateral or bilateral), the effects of plasma aldosterone concentration (PAC), hypokalemia (<3.5 mEq/L), suspected subclinical hypercortisolism (SH; serum cortisol ≥1.8 µg/dL after 1-mg dexamethasone suppression test), and PA laterality on the prevalence of diabetes or prediabetes (5.7% ≤ HbA1c <6.5% [39 mmol/mol ≤ HbA1c <48 mmol/mol]) were examined. RESULTS: Of the 2,210 patients with PA, 477 (21.6%) had diabetes. This prevalence is higher than that in the general population (12.1%) or in 10-year cohorts aged 30-69 years. Logistic regression or χ2 test revealed a significant contribution of suspected SH to diabetes. Despite more active PA profiles (e.g., higher PAC and lower potassium concentrations) in unilateral than bilateral PA, BMI and HbA1c values were significantly higher in bilateral PA. PA laterality had no effect on the prevalence of diabetes; however, the prevalence of prediabetes was significantly higher in bilateral than unilateral PA. CONCLUSIONS: Individuals with PA have a high prevalence of diabetes, which is associated mainly with SH. The prevalence of prediabetes is greater for bilateral than unilateral PA, suggesting a unique metabolic cause of bilateral PA.
OBJECTIVE: To investigate the prevalence and causes of diabetes in patients with primary aldosteronism (PA) in a multi-institutional cohort study in Japan. RESEARCH DESIGN AND METHODS: The prevalence of diabetes was determined in 2,210 patients with PA (diagnosed or glycated hemoglobin [HbA1c] ≥6.5% [≥48 mmol/mol]; NGSP) and compared with that of the Japanese general population according to age and sex. In 1,386 patients with PA and clear laterality (unilateral or bilateral), the effects of plasma aldosterone concentration (PAC), hypokalemia (<3.5 mEq/L), suspected subclinical hypercortisolism (SH; serum cortisol ≥1.8 µg/dL after 1-mg dexamethasone suppression test), and PA laterality on the prevalence of diabetes or prediabetes (5.7% ≤ HbA1c <6.5% [39 mmol/mol ≤ HbA1c <48 mmol/mol]) were examined. RESULTS: Of the 2,210 patients with PA, 477 (21.6%) had diabetes. This prevalence is higher than that in the general population (12.1%) or in 10-year cohorts aged 30-69 years. Logistic regression or χ2 test revealed a significant contribution of suspected SH to diabetes. Despite more active PA profiles (e.g., higher PAC and lower potassium concentrations) in unilateral than bilateral PA, BMI and HbA1c values were significantly higher in bilateral PA. PA laterality had no effect on the prevalence of diabetes; however, the prevalence of prediabetes was significantly higher in bilateral than unilateral PA. CONCLUSIONS: Individuals with PA have a high prevalence of diabetes, which is associated mainly with SH. The prevalence of prediabetes is greater for bilateral than unilateral PA, suggesting a unique metabolic cause of bilateral PA.
Authors: Gail K Adler; Gillian R Murray; Adina F Turcu; Hui Nian; Chang Yu; Carmen C Solorzano; Robert Manning; Dungeng Peng; James M Luther Journal: Hypertension Date: 2020-03-16 Impact factor: 10.190