Higher Blood Urea Nitrogen and Urinary Calcium: New Risk Factors for Diabetes Mellitus in Primary Aldosteronism Patients.

Yu Liu,Kunjie Wang,Yuchun Zhu,Liang Zhou,Zhenghuan Liu,Yucheng Ma,Hong Li,Lede Lin

doi:10.3389/fendo.2020.00023

Abstract

Purpose: The aim of the study was to investigate the prevalence and risk factors of diabetes mellitus (DM) in primary aldosteronism (PA) patients.Methods: This case-control study enrolled 259 PA patients in West China Hospital, China from January 2016 to January 2019. Patients were divided into three groups: PA group, PA + impaired fasting glucose (IFG)/impaired glucose tolerance (IGT) group and PA + DM group. Clinical characteristics (like age and sex) and laboratory variables (like plasma aldosterone concentration and plasma renin activity) were compared between three groups. Univariate and multivariate logistic regression analyses were performed to determine risk factors for DM in PA patients. The association of random blood glucose with the above-mentioned factors were also investigated by Pearson correlation analyses. Nomogram model was developed to predict the probability of DM in PA patients.Results: 49 (18.9%) patients were diagnosed with DM and 22 (8.5%) with IFG/IGT in 259 PA patients. Apart from older age, male, higher body mass index, higher triglycerides and lower cholesterol, we found that higher blood urea nitrogen (BUN) and higher 24 h urinary calcium (Ca) might be potential new risk factors for dysglycemia. The nomogram model for DM in PA patients had a good predictive accuracy, with the area under the curve of receiver operating characteristic of 0.839 (95% CI 0.784–0.893).Conclusions: PA patients were more likely to have DM compared with general population. Apart from older age, overweight and dyslipidemia, higher BUN and excessive excretion of urinary Ca may also be the new potential risk factors for DM in PA patients.

Highlights

Primary aldosteronism (PA) is a disease accompanied with hypertension and hypokalemia caused by excessive secretion of aldosterone from the adrenal glands
It was shown that the mean blood glucose, insulin sensitivity and percentage of diabetes mellitus (DM) were significantly higher in PA patients than those with essential hypertension (EH) [8, 9]
49 (18.9%) patients were diagnosed with DM and 22 (8.5%) with impaired fasting glucose (IFG)/impaired glucose tolerance (IGT)

Summary

Introduction

Primary aldosteronism (PA) is a disease accompanied with hypertension and hypokalemia caused by excessive secretion of aldosterone from the adrenal glands. Recent epidemiological studies found that it was not rare in hypertension patients, with prevalence ranging from 5 to 10% [1, 2]. Diabetes Mellitus in Primary Aldosteronism the incidence of new-onset diabetes mellitus (DM) in PA patients who received adrenalectomy (12.7/1,000) was much lower than that in essential hypertension (EH) controls (28.1/1,000) [4]. PA patients showed an increase of insulin secretion and insulin sensitivity after adrenalectomy [5,6,7]. It was shown that the mean blood glucose, insulin sensitivity and percentage of DM were significantly higher in PA patients than those with EH [8, 9]

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