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Recovery From Diabetes in Patients With Primary Aldosteronism After Adrenalectomy
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This case–control study explored the factors associated with diabetes remission in patients with primary aldosteronism after adrenalectomy. Approximately 50% of the patients noted an improvement in their diabetes or remission of diabetes. Longer duration of hypertension was associated with a lower likelihood for diabetes improvement/remission (OR, 1.007).
- Adrenalectomy was beneficial for improvement/remission of diabetes in half of the patients with primary aldosteronism, with a longer duration of hypertension associated with a lower likelihood of remission.
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND
The prevalence of diabetes mellitus (DM) was higher in primary aldosteronism (PA) patients. We aimed to evaluate the outcome of DM after adrenalectomy and determine the factors associated with that in PA patients.
METHODS
PA patients with DM (PA + DM patients) who received adrenalectomy were recruited into the study. The patients were classified into 3 groups based on their DM conditions after treatment, including "remission", "improved" and "unchanged" groups. Univariate and multivariate logistic regression analysis was conducted to uncover the preoperative factors affecting the outcome of DM after adrenalectomy.
RESULTS
A total of 54 PA + DM patients received adrenalectomy. After adrenalectomy, 16.7%, 33.3% and 50.0% of patients were classified into the "remission", "improved" and "unchanged" groups, respectively. The factors negatively associated with remission or improvement from DM after adrenalectomy were longer duration of hypertension (P = 0.029). Higher concentration of urinary magnesium (P = 0.031) and higher 24 h urinary potassium (P = 0.049) were factors negatively associated with the "remission" from DM after adrenalectomy.
CONCLUSIONS
Adrenalectomy was beneficial for the remission and improvement from DM in the half of PA patients with DM. Longer duration of hypertension, higher concentration of urinary magnesium and higher 24 h urinary potassium may prevent the remission and improvement from DM after adrenalectomy in PA patients. Examination of urinary electrolyte could be considered in PA patients with DM for predicting the outcome of DM after adrenalectomy.
Additional Info
Recovery from diabetes mellitus in primary aldosteronism patients after adrenalectomy
BMC Endocr Disord 2022 Dec 27;22(1)331, Y Liu, L Lin, C Yuan, S Shen, Y Tang, Z Liu, Y Zhu, L ZhouFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Primary aldosteronism (PA) is one of the most common causes of secondary hypertension, and type 2 diabetes mellitus (T2DM) appears to be more prevalent in patients with PA, potentially compounding lifetime cardiovascular risk in these patients. Adrenalectomy is known to be an efficacious and often curative intervention for hypertension when a unilateral adrenal adenoma is identified as the source of aldosterone excess in PA; however, there is some data to suggest that this intervention may improve glucose-related outcomes as well.
To investigate this hypothesis further, the authors conducted a retrospective analysis of 54 patients with T2DM and PA who underwent adrenalectomy at their institution over a 3-year period. One year following their surgery, these patients were divided into three groups — those in “remission” who no longer required antihyperglycemic medications, those who “improved” and had stable or improved glucoses despite being on the same or a de-escalated glucose-lowering regimen as compared with before surgery and finally, those whose glucose control was “unchanged.” They also looked at blood pressure outcomes, separating patients into “remission,” “improved,” and “unchanged” groups based on whether they required no, fewer, or the same number of antihypertensive medications as compared with before surgery, respectively.
The authors found that 50% of patients with PA and T2DM achieved remission or improved diabetes control 1 year following adrenalectomy. Median fasting glucose and HbA1c improved in all patients after adrenal surgery. Although remission or improvement in hypertension after surgery did not correlate with remission or improvement in T2DM, patients who had a longer duration of hypertension were less likely to achieve remission or improvement in their T2DM control. High urinary potassium and urinary magnesium also negatively correlated with remission from T2DM.
The authors propose several potential mechanistic explanations for these findings, but ultimately acknowledge that the limited sample size and retrospective nature of the study make it difficult to draw more definitive conclusions. Ultimately, while these results add to the growing body of evidence that amelioration of aldosterone excess may lead to some improvement in glucose parameters, there is clearly a need for additional, more rigorous investigation into this potentially important relationship.