Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, UniversitätsSpital Zürich, Zürich, Switzerland; Competence Centre of Personalized Medicine, Molecular and Translational Biomedicine PhD Program, University of Zurich, Zurich, Switzerland.
Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, UniversitätsSpital Zürich, Zürich, Switzerland; Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU, Munich, Germany.
Diabetes Metab. 2020 Feb;46(1):1-7. doi: 10.1016/j.diabet.2019.02.003. Epub 2019 Feb 27.
Shortly after the first description of primary aldosteronism (PA) appeared in the 1950s by Jerome Conn, an association of the condition with diabetes mellitus was documented. However, a clear pathophysiological interrelationship linking the two entities has yet to be established. Nevertheless, so far, many mechanisms contributing to insulin resistance and dysregulation of glucose uptake have been described. At the same time, many observational studies have reported an increased prevalence of the metabolic syndrome (MetS) among patients with PA. Regarding the relationship between aldosterone levels and obesity, a vicious cycle of adipokine-induced aldosterone production and aldosterone adipogenic action may be further contributing to MetS manifestations in PA patients. However, whether aldosterone excess affects lipid metabolism is still under investigation. Also, recent findings of the coexistence of glucocorticoid excess in many cases of PA highlight the need for further studies to examine the presumed link between high aldosterone levels and various metabolic parameters. In the present review, our focus is to comprehensively present the spectrum of available research findings concerning the possible associations between aldosterone excess and metabolic alterations, including impaired glucose metabolism, insulin resistance and, consequently, diabetes, altered lipid metabolism and the development of fatty liver. In addition, the complex relationship between obesity and aldosterone is discussed in detail.
原发性醛固酮增多症（PA）于 20 世纪 50 年代由 Jerome Conn 首次描述后不久，就有文献记载该病症与糖尿病之间存在关联。然而，这两种疾病之间尚未建立明确的病理生理学相互关系。尽管如此，迄今为止，已有许多机制被描述与胰岛素抵抗和葡萄糖摄取失调有关。与此同时，许多观察性研究报告称，PA 患者中代谢综合征（MetS）的患病率增加。关于醛固酮水平与肥胖之间的关系，脂肪细胞因子诱导的醛固酮产生和醛固酮致脂肪形成作用的恶性循环可能进一步导致 PA 患者 MetS 表现。然而，醛固酮过多是否影响脂质代谢仍在研究中。此外，最近发现许多 PA 病例中存在糖皮质激素过多，这突显了进一步研究的必要性，以检验高醛固酮水平与各种代谢参数之间假定的联系。在本次综述中，我们的重点是全面介绍关于醛固酮过多与代谢改变之间可能关联的现有研究结果，包括葡萄糖代谢受损、胰岛素抵抗，以及随之而来的糖尿病、脂质代谢改变和脂肪肝的发生。此外，还详细讨论了肥胖与醛固酮之间的复杂关系。
