Department of Endocrinology and Diabetes Mellitus, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
Diabetes Therapeutics and Research Center, Institute of Advanced Medical Sciences, Tokushima University, Tokushima, Japan.
Diabetes Care. 2019 May;42(5):938-945. doi: 10.2337/dc18-1293.
To investigate the prevalence and causes of diabetes in patients with primary aldosteronism (PA) in a multi-institutional cohort study in Japan.
The prevalence of diabetes was determined in 2,210 patients with PA (diagnosed or glycated hemoglobin [HbA] ≥6.5% [≥48 mmol/mol]; NGSP) and compared with that of the Japanese general population according to age and sex. In 1,386 patients with PA and clear laterality (unilateral or bilateral), the effects of plasma aldosterone concentration (PAC), hypokalemia (<3.5 mEq/L), suspected subclinical hypercortisolism (SH; serum cortisol ≥1.8 µg/dL after 1-mg dexamethasone suppression test), and PA laterality on the prevalence of diabetes or prediabetes (5.7% ≤ HbA <6.5% [39 mmol/mol ≤ HbA <48 mmol/mol]) were examined.
Of the 2,210 patients with PA, 477 (21.6%) had diabetes. This prevalence is higher than that in the general population (12.1%) or in 10-year cohorts aged 30-69 years. Logistic regression or χ test revealed a significant contribution of suspected SH to diabetes. Despite more active PA profiles (e.g., higher PAC and lower potassium concentrations) in unilateral than bilateral PA, BMI and HbA values were significantly higher in bilateral PA. PA laterality had no effect on the prevalence of diabetes; however, the prevalence of prediabetes was significantly higher in bilateral than unilateral PA.
Individuals with PA have a high prevalence of diabetes, which is associated mainly with SH. The prevalence of prediabetes is greater for bilateral than unilateral PA, suggesting a unique metabolic cause of bilateral PA.
在日本多机构队列研究中，调查原发性醛固酮增多症（PA）患者的糖尿病患病率及其病因。
根据年龄和性别，确定了 2210 例 PA 患者（诊断或糖化血红蛋白[HbA]≥6.5%[≥48mmol/mol]；NGSP）中糖尿病的患病率，并与日本普通人群进行了比较。在 1386 例明确单侧或双侧病变的 PA 患者中，检测了血浆醛固酮浓度（PAC）、低钾血症（<3.5mEq/L）、疑似亚临床皮质醇增多症（SH；1 毫克地塞米松抑制试验后血清皮质醇≥1.8μg/dL）以及 PA 病变侧对糖尿病或糖尿病前期（5.7%≤HbA<6.5%[39mmol/mol≤HbA<48mmol/mol]）患病率的影响。
在 2210 例 PA 患者中，477 例（21.6%）患有糖尿病。这一患病率高于普通人群（12.1%）或 30-69 岁 10 年队列。Logistic 回归或卡方检验显示，疑似 SH 对糖尿病有显著影响。尽管单侧 PA 的 PA 特征更活跃（例如，PAC 更高，钾浓度更低），但双侧 PA 的 BMI 和 HbA 值明显更高。PA 病变侧对糖尿病患病率没有影响；然而，双侧 PA 的糖尿病前期患病率明显高于单侧 PA。
PA 患者的糖尿病患病率较高，主要与 SH 相关。双侧 PA 的糖尿病前期患病率高于单侧 PA，表明双侧 PA 存在独特的代谢病因。
