Background: Primary aldosteronism (PA) is associated with increased prevalence of metabolic disorders (impaired glucose and lipid metabolism and insulin resistance), but also with more frequent cardiovascular, renal and central nervous system complications.
Methods: Biochemical and clinical parameters were retrospectively analysed for 40 patients with PA caused by aldosterone-producing adenoma (APA) and compared to the control groups of 40 patients with nonfunctioning adrenal adenoma (NFA) and essential hypertension (HT), and 20 patients with adrenal Cushing syndrome (CS) or subclinical CS (SCS).
Results: Systolic, diastolic and mean arterial blood pressures were significantly higher in the PA group (p=0.004; p=0.002; p=0.001, respectively) than in NFA+HT group. PA patients had longer hypertension history (p=0.001) than patients with hypercorticism and all had hypokalaemia. This group showed the smallest mean tumour diameter (p<0.001). The metabolic syndrome was significantly less common in the PA group (37.5% vs. 70% in CS+SCS and 65% in NFA+HT group; p=0.015), although there was no significant difference in any of the analysed metabolic parameters between groups. PA group was found to have the most patients with glucose intolerance (81.8%), although the difference was not significant. The mean BMI for all three groups was in the overweight range. Patients with PA had higher microalbuminuria and a higher tendency for cardiovascular, renal and cerebrovascular events, but the difference was not significant.
Conclusions: Our results support the importance of the early recognition of primary aldosteronism on the bases of clinical presentation, as well as an increased screening intensity.
Uvod: Primarni aldosteronizam (PA) je praćen povećanom prevalencom metaboličkih poremećaja, (oštećen glukozni i lipidni metabolizam i insulinska rezistencija), ali i češćim kardio vaskularnim, renalnim i komplikacijama centralnog nervnog sistema.
Metode: Analizirane su retrospektivno biohemijske i kliničke karakteristike 40 pacijenata sa PA zbog aldosteron-produkujućeg adenoma (APA) i upoređene sa kontrolnim grupama od 40 pacijenata sa afunkcionim adrenalnim adenomom (NFA) i esencijalnom hipertenzijom (HT), i 20 pacijenata sa adrenalnim Cushing-ovim sindromom (CS) ili subkliničkim CS (SCS).
Rezultati: Sistolni, dijastolni i srednji arterijski pritisci su bili značajno viši u grupi sa PA (p=0,004; p=0,002; p=0,001, redom) nego u grupi NFA+HT. PA pacijenti su imali dužu istoriju hipertenzije (p=0,001) nego pacijenti sa hiperkorticizmom i svi su imali hipokalemiju. Ova grupa je imala najmanji srednji prečnik tumora (p<0,001). Metabolički sindrom je bio značajno ređi u PA grupi (37,5% vs. 70% u CS+SCS i 65% u NFA+HT grupi; p=0,015), mada nije bilo značajne razlike u bilo kom analiziranom metaboličkom parametru među grupama. U PA grupi je nađen najveći procenat pacijenata sa glikoznom intolerancijom (81,8%), mada razlika nije bila značajna. Srednja vrednost BMI za sve tri grupe je bila u rangu prekomerne težine. Pacijenti sa PA su imali veći stepen mikroalbuminurije, veću tendencija ka javljanju kardiovaskularnih, renalnih i cerebrovaskularnih događaja, ali razlika nije bila značajna.
Zaključak: Naši rezultati podržavaju značaj ranog prepoznavanja primarnog aldosteronizma na osnovu kliničke prezentacije, ali i povećanog korišćenja skrininga.
Keywords: Cushing syndrome; adrenal tumour; biochemical parameters; clinical presentation; hypertension; primary aldosteronism.
2020 Nataša Vujačić, Ivan Paunović, Aleksandar Diklić, Vladan Živaljević, Nikola Slijepčević, Nevena Kalezić, Mirjana Stojković, Miloš Stojanović, Biljana Beleslin, Miloš Žarković, Jasmina Ćirić, published by CEON/CEES.