Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ziemssenstrasse 1, 80336 München, Germany.
J Clin Endocrinol Metab. 2013 Jun;98(6):2513-20. doi: 10.1210/jc.2012-3934. Epub 2013 Mar 28.
Primary aldosteronism (PA) represents the most frequent cause of secondary arterial hypertension. Conflicting data have been published regarding the effect of aldosterone excess on glucose metabolism.
Our aim was to analyze insulin sensitivity and β-cell function in a cohort of PA patients. Prospective follow-up investigations were performed in a subgroup of patients before and after adrenalectomy to assess the metabolic outcome.
Oral glucose tolerance test, combined intravenous glucose tolerance test, hyperinsulinemic-euglycemic glucose clamp test, and arginine test were carried out after a 12-hour fasting period.
Twenty-two consecutive patients with both unilateral aldosterone-producing adenoma and bilateral idiopathic adrenal hyperplasia were recruited through the Munich center of the German Conn's Registry. The control group of patients with essential hypertension (n = 11) of corresponding age and body mass index was recruited from our hypertension unit. A normotensive cohort (n = 11) served as a further control group.
At baseline, first-phase insulin reaction in intravenous glucose tolerance test was significantly reduced in patients with PA as compared to normal controls (36.0 [24.0; 58.7] vs 90.1 [52.6; 143.8] μU/mL, P = .031) and lower in comparison to essential hypertension without reaching statistical significance (53.2 [30.8; 73.3] μU/mL, P = .123). The study was repeated 6 months after unilateral adrenalectomy in 9 consecutive patients with aldosterone-producing adenoma. At this time point, blood pressure had been normalized in most of the patients while body mass index remained unchanged (26.9 [25.5; 37.6] vs 27.5 [25.1; 35.6] kg/m(2), P = .401). First-phase insulin reaction in response to glucose significantly increased at follow-up (from 36.0 [25.5; 58.7] to 48.5 [40.4; 95.2] μU/mL, P = .038, n = 9). In contrast, insulin sensitivity and response to iv arginine did not differ before and after adrenalectomy.
Aldosterone excess has a direct negative effect on β-cell function in patients with PA. After adrenalectomy, glucose-induced first-phase insulin secretion improves significantly in the patients.
原发性醛固酮增多症（PA）是继发性动脉高血压最常见的原因。醛固酮过多对糖代谢的影响存在相互矛盾的数据。
我们旨在分析一组 PA 患者的胰岛素敏感性和β细胞功能。对肾上腺切除术前后的亚组患者进行前瞻性随访调查，以评估代谢结果。
口服葡萄糖耐量试验、联合静脉葡萄糖耐量试验、高胰岛素-正葡萄糖钳夹试验和精氨酸试验在禁食 12 小时后进行。
通过德国 Conn's 登记处的慕尼黑中心，连续招募了 22 例单侧醛固酮分泌腺瘤和双侧特发性肾上腺增生的患者。选择年龄和体重指数相匹配的原发性高血压患者（n = 11）作为对照组。另一个正常血压组（n = 11）作为进一步的对照组。
基线时，与正常对照组相比，PA 患者的静脉葡萄糖耐量试验第一时相胰岛素反应明显降低（36.0[24.0;58.7] vs 90.1[52.6;143.8]μU/mL，P =.031），且低于原发性高血压患者，但差异无统计学意义（53.2[30.8;73.3]μU/mL，P =.123）。9 例醛固酮分泌腺瘤患者在单侧肾上腺切除术 6 个月后重复了该研究。此时，大多数患者的血压已正常，而体重指数保持不变（26.9[25.5;37.6] vs 27.5[25.1;35.6]kg/m2，P =.401）。葡萄糖刺激的第一时相胰岛素反应在随访时显著增加（从 36.0[25.5;58.7]至 48.5[40.4;95.2]μU/mL，P =.038，n = 9）。相比之下，肾上腺切除术前后胰岛素敏感性和静脉内精氨酸反应没有差异。
醛固酮过多对 PA 患者的β细胞功能有直接的负性影响。肾上腺切除术后，患者的葡萄糖诱导的第一时相胰岛素分泌明显改善。
