Abstract
Background and aimsPrimary aldosteronism (PA) due to unilateral aldosterone-producing adenoma (APA) is preferentially treated by unilateral adrenalectomy (ADX), but little is known about the changes in lipid and glucose metabolism that may occur after ADX.MethodsWe studied 19 non-diabetic patients who did not use lipid-lowering drugs with PA due to APA before and 6 months after unilateral ADX. Fasting plasma lipids, lipoprotein subfractions, branched-chain amino acids (BCAA), and GlycA, a pro-inflammatory glycoprotein biomarker, were measured by nuclear magnetic resonance (NMR) spectroscopy. The Lipoprotein Insulin Resistance (LP-IR) score, which is based on six lipoprotein variables, was calculated.ResultsIn all patients, hyperaldosteronism was resolved after ADX. Body mass index and fasting plasma glucose were unchanged, but HbA1c increased (p = 0.002). Plasma triglycerides, large triglyceride-rich lipoprotein (TRL) cholesterol, and large TRL particles were increased (p < 0.01), resulting in an increase in TRL size (p = 0.027). High-density lipoprotein size was decreased (p = 0.015). LP-IR scores (p = 0.001) and total BCAA (p = 0.017) were increased, but GlycA remained unaltered.ConclusionsBased on increases in LP-IR scores and BCAA, which each have been shown to predict new onset type 2 diabetes mellitus independent of conventional risk factors in the general population, this preliminary study suggests that diabetes risk is not improved but may even be increased after ADX for APA despite remission of PA.
Highlights
Primary aldosteronism (PA) is a well-recognized and rather frequent cause of secondary hypertension with deleterious effects on cardiometabolic health including high prevalence of Type 2 diabetes mellitus (T2D) [1,2,3,4,5]
The diameters for the lipoprotein classes reported by the LP4 algorithm are triglyceride-rich lipoprotein (TRL) particles (TRL-P) (24–240 nm), LDL particles (LDL-P) (19–23 nm), and HDL particles (HDL-P) (7.4–12.0 nm)
Adrenal-venous sampling pointed to unilateral disease in all of them, with a right sided aldosterone-producing adenoma (APA) in ten and a left sided APA in nine patients
Summary
Primary aldosteronism (PA) is a well-recognized and rather frequent cause of secondary hypertension with deleterious effects on cardiometabolic health including high prevalence of Type 2 diabetes mellitus (T2D) [1,2,3,4,5]. Besides proinflammatory effects of aldosterone [6, 7], PA is likely to be associated with yet incompletely understood abnormalities. These authors contributed : Christian Adolf, Annika M. Methods We studied 19 non-diabetic patients who did not use lipid-lowering drugs with PA due to APA before and 6 months after unilateral ADX. Lipoprotein subfractions, branched-chain amino acids (BCAA), and GlycA, a pro-inflammatory glycoprotein biomarker, were measured by nuclear magnetic resonance (NMR) spectroscopy. Large triglyceride-rich lipoprotein (TRL) cholesterol, and large TRL particles were increased (p < 0.01), resulting in an increase in TRL size (p = 0.027).
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