Endocrinology in Charlottenburg, 10627 Berlin, Germany.
Clinical Endocrinology CCM, Charité Universitätsmedizin Berlin, 10117 Berlin, Germany.
Eur J Endocrinol. 2024 Sep 30;191(4):444-456. doi: 10.1093/ejendo/lvae119.
Patients with primary aldosteronism (PA) have higher cardiac comorbidities including more pronounced left ventricular hypertrophy than patients with essential hypertension.
Autonomous cortisol cosecretion (ACS) is a common subtype in PA associated with a worse metabolic profile.
Autonomous cortisol cosecretion may affect myocardial parameters and result in a worse cardiac outcome compared to patients with PA and without ACS.
Three hundred and sixty-seven patients with PA undergoing 1 mg dexamethasone suppression test (DST) and echocardiography at baseline from 2 centers of the German Conn's Registry were included. Follow-up for up to 3.8 years was available in 192 patients.
Patients with PA and ACS had higher NT-proBNP levels at baseline compared to patients with PA without ACS (114 vs 75.6 pg/mL, P = .02), but showed no difference in echocardiography values. NT-proBNP levels showed a significant positive correlation (r = 0.141, P = .011) with cortisol levels after DST at baseline. In response to therapy of PA, NT-proBNP levels decreased, but remained significantly higher in patients with ACS compared to patients without ACS. At follow-up, left ventricle end-diastolic dimension (LVEDD) decreased significantly only in patients without ACS. Left atrial diameter (LAD) decreased significantly in patients without ACS and in female patients with ACS but not in male patients. Left ventricular mass index (LVMI) significantly improved in female patients without ACS but remained unchanged in female patients with ACS as well as in male patients at follow-up.
In patients with PA, concomitant ACS is associated with a worse cardiac profile and only partial recovery even years after initiation of targeted PA therapy.
原发性醛固酮增多症（PA）患者的心脏合并症发生率较高，包括左心室肥厚更为明显，比原发性高血压患者更严重。
自主皮质醇分泌（ACS）是 PA 的常见亚型，与更差的代谢特征相关。
自主皮质醇分泌可能会影响心肌参数，并导致比没有 ACS 的 PA 患者更差的心脏结局。
纳入了来自德国 Conn 登记处的 2 个中心的 367 名接受 1mg 地塞米松抑制试验（DST）和基线超声心动图检查的 PA 患者。在 192 名患者中，可获得长达 3.8 年的随访。
与没有 ACS 的 PA 患者相比，ACS 的 PA 患者的基线 NT-proBNP 水平更高（114 比 75.6 pg/ml，P =.02），但超声心动图值无差异。NT-proBNP 水平与基线 DST 后皮质醇水平呈显著正相关（r = 0.141，P =.011）。PA 治疗后，NT-proBNP 水平降低，但 ACS 患者仍显著高于无 ACS 患者。随访时，仅无 ACS 的患者 LVEDD 显著降低。无 ACS 的患者 LAD 显著降低，ACS 的女性患者及无 ACS 的男性患者的左心室质量指数（LVMI）显著改善。
在 PA 患者中，并发 ACS 与更差的心脏特征相关，即使在开始针对 PA 的靶向治疗多年后，也只能部分恢复。
