García-Cano, A.M. (Ana María)

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    Effect of obesity on clinical characteristics of primary aldosteronism patients at diagnosis and postsurgical responsei
    (2023) Díaz-Guardiola, P. (Patricia); Morales, M. (Manuel); Perdomo-Zelaya, C.M. (Carolina M.); Ferreira, R. (Rui); Percovich, J.C. (Juan Carlos); Ruiz-Sanchez, J.G. (Jorge Gabriel); Manjón, L. (Laura); Picón-César, M.J. (María José); González-Boillos, M. (Marga); Martín-Rojas-Marcos, P. (Patricia); Hanzu, F. (Felicia); Gracia-Gimeno, P. (Paola); Gómez-Hoyos, E. (Emilia); García-Sanz, I. (Íñigo); Pla-Peris, B. (Begoña); Vicente-Delgado, A. (Almudena); Recasens, M. (Mónica); Araujo-Castro, M. (Marta); Pascual-Corrales, E. (Eider); Parra-Ramírez, P. (Paola); García-Centeno, R. (Rogelio); Rebollo-Román, A. (Angel); García-Cano, A.M. (Ana María); Paja, M. (Miguel); Barahona-San-Millan, R. (Rebeca); García-González, J.J. (Juan Jesús); Robles-Lázaro, C. (Cristina)
    BACKGROUND: Patients with obesity have an overactivated renin-angiotensin-aldosterone system (RAAS) that is associated with essential hypertension. However, the influence of obesity in primary aldosteronism (PA) is unknown. We analyzed the impact of obesity on the characteristics of PA, and the association between obesity and RAAS components. METHODS: Retrospective study of the Spanish PA Registry (SPAIN-ALDO Registry), which included patients with PA seen at 20 tertiary centers between 2018-2022. Differences between patients with and without obesity were analyzed. RESULTS: 415 patients were included; 189 (45.5%) with obesity. Median age: 55 years [47.3-65.2] and 240 (58.4%) were male. Compared to those without obesity, patients with obesity had higher rates of diabetes mellitus, chronic kidney disease, obstructive apnea syndrome, left ventricular hypertrophy, prior cardiovascular events, higher means of systolic blood pressure (BP) and required more antihypertensive drugs. Patients with PA and obesity also had higher values of serum glucose, HbA1c, creatinine, uric acid, and triglycerides, and lower levels of HDL-cholesterol. Levels of blood aldosterone (PAC) and renin were similar between patients with and without obesity. Body mass index was not correlated with PAC nor renin. The rates of adrenal lesions on imaging studies, as well as the rates of unilateral disease assessed by adrenal vein sampling or I-6beta-iodomethyl-19-norcholesterol scintigraphy were similar between groups. CONCLUSION: Obesity in PA patients involves a worse cardiometabolic profile, and need for more antihypertensive drugs but similar PAC and renin levels, and rates of adrenal lesions and lateral disease than patients without obesity. However, obesity implicates a lower rate of hypertension cure after adrenalectomy.
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    Autonomous cortisol secretion in patients with primary aldosteronism: prevalence and implications on cardiometabolic profile and on surgical outcomes
    (European Society of Endocrinology, 2023) Díaz-Guardiola, P. (Patricia); Morales, M. (Manuel); Calatayud, M. (Maria); Ferreira, R. (Rui); Sampedro-Nuñez, M.A. (Miguel Antonio); Meneses, D. (Diego); Percovich, J.C. (Juan Carlos); Ruiz-Sanchez, J.G. (Jorge Gabriel); Del-Castillo-Tous, M; Serrano, J. (Joaquín); Manjón, L. (Laura); Picón-César, M.J. (María José); González-Boillos, M. (Marga); Martín-Rojas-Marcos, P. (Patricia); Hanzu, F. (Felicia); Gonzalvo-Diaz, C. (César); Gracia-Gimeno, P. (Paola); Gómez-Hoyos, E. (Emilia); Perdomo, C. (Carolina); García-Sanz, I. (Íñigo); Pla-Peris, B. (Begoña); Michalopoulou, T. (Theodora); Recasens, M. (Mónica); Araujo-Castro, M. (Marta); Pascual-Corrales, E. (Eider); Parra-Ramírez, P. (Paola); García-Centeno, R. (Rogelio); Rebollo-Román, A. (Angel); Escudero-Quesada, V. (Verónica); García-Cano, A.M. (Ana María); Vicente, A. (Almudena); Sanmartín-Sánchez, A. (Alicia); Paja, M. (Miguel); Moya-Mateo, E.M. (Eva María); Barahona-San-Millan, R. (Rebeca); Lamas, C. (Cristina); Furio-Collao, S.A. (Simone Andree); Mena-Ribas, E. (Elena); Guerrero-Vázquez, R. (Raquel); Robles-Lázaro, C. (Cristina)
    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.