Araujo-Castro Marta, Paja Fano Miguel, Pla Peris Begoña, González Boillos Marga, Pascual-Corrales Eider, García-Cano Ana María, Parra Ramírez Paola, Rojas-Marcos Patricia Martín, Ruiz-Sanchez Jorge Gabriel, Vicente Almudena, Gómez-Hoyos Emilia, Ferreira Rui, García Sanz Iñigo, Recasens Mónica, Barahona San Millan Rebeca, Picón César María José, Díaz Guardiola Patricia, Perdomo Carolina, Manjón Laura, García-Centeno Rogelio, Percovich Juan Carlos, Rebollo Román Ángel, Gracia Gimeno Paola, Robles Lázaro Cristina, Morales Manuel, Calatayud María, Collao Simone Andree Furio, Meneses Diego, Sampedro Nuñez Miguel Antonio, Escudero Quesada Verónica, Ribas Elena Mena, Sanmartín Sánchez Alicia, Diaz Cesar Gonzalvo, Lamas Cristina, Guerrero-Vázquez Raquel, Del Castillo Tous María, Serrano Joaquín, Michalopoulou Theodora, Moya Mateo Eva María, Hanzu Felicia
Department of Endocrinology & Nutrition, Hospital Universitario Ramón y Cajal & Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Madrid, Spain.
University of Alcalá, Madrid, Spain.
Endocr Connect. 2023 Aug 2;12(9):e230043. doi: 10.1530/EC-23-0043.
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.
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.
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.
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.
本研究旨在评估原发性醛固酮增多症（PA）患者自主皮质醇分泌（ACS）的患病率及其对心脏代谢和手术结局的影响。
这是一项对21家西班牙三级医院在诊断检查期间接受1毫克地塞米松抑制试验（DST）的PA患者进行的回顾性多中心研究。ACS定义为在无皮质醇增多症特定临床特征的情况下，DST后皮质醇>1.8μg/dL（若>5μg/dL为确诊ACS，若1.8 - 5μg/dL为可能ACS）。将心脏代谢情况与年龄和DST水平匹配的无PA的ACS对照组（ACS组）进行比较。
PA患者总体队列（n = 176）中ACS的患病率为29%（ACS - PA；n = 51）。10例患者确诊ACS，41例可能ACS。ACS - PA组和仅PA组患者的心脏代谢情况相似，但ACS - PA组患者年龄更大，肾上腺病变肿瘤更大。比较ACS - PA组（n = 51）和ACS组（n = 78），ACS - PA患者的高血压患病率（OR 7.7（2.64 - 22.32））和心血管事件患病率（OR 5.0（2.29 - 11.07））高于ACS患者。PA患者中ACS的共存不影响手术结局，ACS - PA组和仅PA组的生化治愈和临床治愈比例相似。
皮质醇和醛固酮的共同分泌影响近三分之一的PA患者。其在肿瘤较大和年龄较大的患者中更常见。然而，ACS - PA患者和仅PA患者的心脏代谢和手术结局相似。
