Autonomous cortisol secretion in patients with primary aldosteronism: prevalence and implications on cardiometabolic profile and on surgical outcomes

Author:

Araujo-Castro Marta12ORCID,Paja Fano Miguel3,Pla Peris Begoña4,González Boillos Marga4,Pascual-Corrales Eider1,García-Cano Ana María5,Parra Ramírez Paola6,Rojas-Marcos Patricia Martín6,Ruiz-Sanchez Jorge Gabriel7,Vicente Almudena8,Gómez-Hoyos Emilia9,Ferreira Rui10,García Sanz Iñigo11,Recasens Mónica12,Barahona San Millan Rebeca12,Picón César María José13,Díaz Guardiola Patricia14,Perdomo Carolina15,Manjón Laura16,García-Centeno Rogelio17,Percovich Juan Carlos17,Rebollo Román Ángel18,Gracia Gimeno Paola19,Robles Lázaro Cristina20,Morales Manuel21,Calatayud María22,Collao Simone Andree Furio22,Meneses Diego7,Sampedro Nuñez Miguel Antonio23,Escudero Quesada Verónica24,Ribas Elena Mena25,Sanmartín Sánchez Alicia25,Diaz Cesar Gonzalvo26,Lamas Cristina26,Guerrero-Vázquez Raquel27,del Castillo Tous María27,Serrano Joaquín28,Michalopoulou Theodora29,Moya Mateo Eva María30,Hanzu Felicia31

Affiliation:

1. Department of Endocrinology & Nutrition, Hospital Universitario Ramón y Cajal & Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Madrid, Spain

2. University of Alcalá, Madrid, Spain

3. Department of Endocrinology & Nutrition, OSI Bilbao-Basurto, Hospital Universitario de Basurton & Basque Country University, Medicine Department, Bilbao, Spain

4. Department of Endocrinology & Nutrition, Hospital Universitario de Castellón, Castellón, Spain

5. Department of Biochemistry, Hospital Universitario Ramón y Cajal, Madrid, Spain

6. Department of Endocrinology & Nutrition, Hospital Universitario La Paz Madrid, Spain

7. Department of Endocrinology & Nutrition, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain

8. Department of Endocrinology & Nutrition, Hospital Universitario de Toledo, Toledo, Spain

9. Department of Endocrinology & Nutrition, Hospital Universitario de Valladolid, Valladolid, Spain

10. Department of Endocrinology & Nutrition, Hospital Universitario Rey Juan Carlos, Madrid, Spain

11. Department of General & Digestive Surgery, Hospital Universitario de La Princesa, Madrid, Spain

12. Department of Endocrinology & Nutrition, Institut Català de la Salut Girona, Girona, Spain

13. Department of Endocrinology & Nutrition, Hospital Universitario Virgen de la Victoria de Málaga, IBIMA Malaga, Spain CIBEROBN, Madrid, Spain

14. Department of Endocrinology & Nutrition, Hospital Universitario Infanta Sofía, Madrid, Spain

15. Department of Endocrinology & Nutrition, Clínica Universidad de Navarra, Pamplona, Spain

16. Department of Endocrinology & Nutrition, Hospital Universitario Central de Asturias & Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain

17. Department of Endocrinology & Nutrition, Hospital Universitario Gregorio Marañón, Madrid, Spain

18. Department of Endocrinology & Nutrition, Hospital Reina Sofía, Córdoba, Spain

19. Department of Endocrinology & Nutrition, Hospital Rollo Villanova, Zaragoza, Spain

20. Department of Endocrinology & Nutrition, Complejo Universitario de Salamanca, Salamanca, Spain

21. Biochemistry and Molecular Genetics Department-CDB, Hospital Clinic, IDIBAPS, CIBERehd, Barcelona, Spain

22. Department of Endocrinology & Nutrition, Hospital Doce de Octubre, Madrid, Spain

23. Department of Endocrinology & Nutrition, Hospital Universitario La Princesa, Madrid, Spain

24. Department of Nephrology, Hospital Universitario Doctor Peser, Valencia, Spain

25. Department of Endocrinology & Nutrition, Hospital Universitario Son Espases, Islas Baleares, Spain

26. Department of Endocrinology & Nutrition, Hospital Universitario De Albacete, Albacete, Spain

27. Department of Endocrinology & Nutrition, Hospital Virgen de la Macarena, Sevilla, Spain

28. Department of Endocrinology & Nutrition, Hospital General Universitario de Alicante, Alicante, Spain

29. Department of Endocrinology and Nutrition, Joan XXIII University Hospital, Tarragona, Spain

30. Internal Medicine, Hospital Infanta Leonor de Vallecas, Madrid, Spain

31. Department of Endocrinology & Nutrition, Hospital Clinic, IDIPAS, Barcelona, Spain

Abstract

Purpose The aim of this study was to evaluate the prevalence of autonomous cortisol secretion (ACS) in patients with primary aldosteronism (PA) and its implications on cardiometabolic and surgical outcomes. Methods This is a retrospective multicenter study of PA patients who underwent 1 mg dexamethasone-suppression test (DST) during diagnostic workup in 21 Spanish tertiary hospitals. ACS was defined as a cortisol post-DST >1.8 µg/dL (confirmed ACS if >5 µg/dL and possible ACS if 1.8–5 µg/dL) in the absence of specific clinical features of hypercortisolism. The cardiometabolic profile was compared with a control group with ACS without PA (ACS group) matched for age and DST levels. Results The prevalence of ACS in the global cohort of patients with PA (n = 176) was 29% (ACS–PA; n = 51). Ten patients had confirmed ACS and 41 possible ACS. The cardiometabolic profile of ACS–PA and PA-only patients was similar, except for older age and larger tumor size of the adrenal lesion in the ACS–PA group. When comparing the ACS–PA group (n = 51) and the ACS group (n = 78), the prevalence of hypertension (OR 7.7 (2.64–22.32)) and cardiovascular events (OR 5.0 (2.29–11.07)) was higher in ACS–PA patients than in ACS patients. The coexistence of ACS in patients with PA did not affect the surgical outcomes, the proportion of biochemical cure and clinical cure being similar between ACS–PA and PA-only groups. Conclusion Co-secretion of cortisol and aldosterone affects almost one-third of patients with PA. Its occurrence is more frequent in patients with larger tumors and advanced age. However, the cardiometabolic and surgical outcomes of patients with ACS–PA and PA-only are similar.

Publisher

Bioscientifica

Subject

Endocrinology,Endocrinology, Diabetes and Metabolism,Internal Medicine

Reference37 articles.

1. Study heterogeneity and estimation of prevalence of primary aldosteronism: a systematic review and meta-regression analysis;Käyser,2016

2. Cardiovascular events and target organ damage in primary aldosteronism compared with essential hypertension: a systematic review and meta-analysis;Monticone,2018

3. Autonomous cortisol secretion in adrenal incidentalomas;Araujo-Castro,2019

4. Steroid metabolome analysis reveals prevalent glucocorticoid excess in primary aldosteronism;Arlt,2017

5. Autonomous cortisol secretion is associated with worse arterial stiffness and vascular fibrosis in primary aldosteronism: a cross-sectional study with follow-up data;Tsai,2022

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