High prevalence of diabetes in patients with primary aldosteronism (PA) associated with subclinical hypercortisolism and prediabetes more prevalent in bilateral than unilateral PA

A large, multicenter cohort study in Japan

behalf of the Japan Primary Aldosteronism Study Group

Research output: Contribution to journalArticle

Abstract

OBJECTIVE To investigate the prevalence and causes of diabetes in patients with primary aldosteronism (PA) in a multi-institutional cohort study in Japan. RESEARCH DESIGN AND METHODS The prevalence of diabetes was determined in 2,210 patients with PA (diagnosed or glycated hemoglobin [HbA 1c ] ‡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 mg/dL after 1-mg dexamethasone suppression test), and PA laterality on the prevalence of diabetes or prediabetes (5.7% £ HbA 1c <6.5% [39 mmol/mol £ HbA 1c <48 mmol/mol]) were examined. RESULTS 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 x 2 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 1c 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. CONCLUSIONS 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.

Original languageEnglish
Pages (from-to)938-945
Number of pages8
JournalDiabetes care
Volume42
Issue number5
DOIs
Publication statusPublished - 2019 May 1

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Prediabetic State
Hyperaldosteronism
Cushing Syndrome
Multicenter Studies
Japan
Cohort Studies
Aldosterone
Hypokalemia
Glycosylated Hemoglobin A
Dexamethasone
Population
Hydrocortisone

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialised Nursing

Cite this

@article{f236416dac6f484b9dea17f732328346,
title = "High prevalence of diabetes in patients with primary aldosteronism (PA) associated with subclinical hypercortisolism and prediabetes more prevalent in bilateral than unilateral PA: A large, multicenter cohort study in Japan",
abstract = "OBJECTIVE To investigate the prevalence and causes of diabetes in patients with primary aldosteronism (PA) in a multi-institutional cohort study in Japan. RESEARCH DESIGN AND METHODS The prevalence of diabetes was determined in 2,210 patients with PA (diagnosed or glycated hemoglobin [HbA 1c ] ‡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 mg/dL after 1-mg dexamethasone suppression test), and PA laterality on the prevalence of diabetes or prediabetes (5.7{\%} £ HbA 1c <6.5{\%} [39 mmol/mol £ HbA 1c <48 mmol/mol]) were examined. RESULTS 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 x 2 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 1c 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. CONCLUSIONS 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.",
author = "{behalf of the Japan Primary Aldosteronism Study Group} and Yuko Akehi and Toshihiko Yanase and Ryoko Motonaga and Hironobu Umakoshi and Mika Tsuiki and Yoshiyu Takeda and Takashi Yoneda and Isao Kurihara and Hiroshi Itoh and Takuyuki Katabami and Takamasa Ichijo and Norio Wada and Yui Shibayama and Takanobu Yoshimoto and Kenji Ashida and Yoshihiro Ogawa and Junji Kawashima and Masakatsu Sone and Nobuya Inagaki and Katsutoshi Takahashi and Megumi Fujita and Minemori Watanabe and Yuichi Matsuda and Hiroki Kobayashi and Hirotaka Shibata and Kohei Kamemura and Michio Otsuki and Yuichi Fujii and Koichi Yamamoto and Atsushi Ogo and Shintaro Okamura and Shozo Miyauchi and Tomikazu Fukuoka and Shoichiro Izawa and Shigeatsu Hashimoto and Masanobu Yamada and Yuichiro Yoshikawa and Tatsuya Kai and Tomoko Suzuki and Takashi Kawamura and Mitsuhide Naruse",
year = "2019",
month = "5",
day = "1",
doi = "10.2337/dc18-1293",
language = "English",
volume = "42",
pages = "938--945",
journal = "Diabetes Care",
issn = "1935-5548",
publisher = "American Diabetes Association Inc.",
number = "5",

}

TY - JOUR

T1 - High prevalence of diabetes in patients with primary aldosteronism (PA) associated with subclinical hypercortisolism and prediabetes more prevalent in bilateral than unilateral PA

T2 - A large, multicenter cohort study in Japan

AU - behalf of the Japan Primary Aldosteronism Study Group

AU - Akehi, Yuko

AU - Yanase, Toshihiko

AU - Motonaga, Ryoko

AU - Umakoshi, Hironobu

AU - Tsuiki, Mika

AU - Takeda, Yoshiyu

AU - Yoneda, Takashi

AU - Kurihara, Isao

AU - Itoh, Hiroshi

AU - Katabami, Takuyuki

AU - Ichijo, Takamasa

AU - Wada, Norio

AU - Shibayama, Yui

AU - Yoshimoto, Takanobu

AU - Ashida, Kenji

AU - Ogawa, Yoshihiro

AU - Kawashima, Junji

AU - Sone, Masakatsu

AU - Inagaki, Nobuya

AU - Takahashi, Katsutoshi

AU - Fujita, Megumi

AU - Watanabe, Minemori

AU - Matsuda, Yuichi

AU - Kobayashi, Hiroki

AU - Shibata, Hirotaka

AU - Kamemura, Kohei

AU - Otsuki, Michio

AU - Fujii, Yuichi

AU - Yamamoto, Koichi

AU - Ogo, Atsushi

AU - Okamura, Shintaro

AU - Miyauchi, Shozo

AU - Fukuoka, Tomikazu

AU - Izawa, Shoichiro

AU - Hashimoto, Shigeatsu

AU - Yamada, Masanobu

AU - Yoshikawa, Yuichiro

AU - Kai, Tatsuya

AU - Suzuki, Tomoko

AU - Kawamura, Takashi

AU - Naruse, Mitsuhide

PY - 2019/5/1

Y1 - 2019/5/1

N2 - OBJECTIVE To investigate the prevalence and causes of diabetes in patients with primary aldosteronism (PA) in a multi-institutional cohort study in Japan. RESEARCH DESIGN AND METHODS The prevalence of diabetes was determined in 2,210 patients with PA (diagnosed or glycated hemoglobin [HbA 1c ] ‡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 mg/dL after 1-mg dexamethasone suppression test), and PA laterality on the prevalence of diabetes or prediabetes (5.7% £ HbA 1c <6.5% [39 mmol/mol £ HbA 1c <48 mmol/mol]) were examined. RESULTS 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 x 2 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 1c 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. CONCLUSIONS 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.

AB - OBJECTIVE To investigate the prevalence and causes of diabetes in patients with primary aldosteronism (PA) in a multi-institutional cohort study in Japan. RESEARCH DESIGN AND METHODS The prevalence of diabetes was determined in 2,210 patients with PA (diagnosed or glycated hemoglobin [HbA 1c ] ‡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 mg/dL after 1-mg dexamethasone suppression test), and PA laterality on the prevalence of diabetes or prediabetes (5.7% £ HbA 1c <6.5% [39 mmol/mol £ HbA 1c <48 mmol/mol]) were examined. RESULTS 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 x 2 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 1c 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. CONCLUSIONS 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.

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UR - http://www.scopus.com/inward/citedby.url?scp=85065117204&partnerID=8YFLogxK

U2 - 10.2337/dc18-1293

DO - 10.2337/dc18-1293

M3 - Article

VL - 42

SP - 938

EP - 945

JO - Diabetes Care

JF - Diabetes Care

SN - 1935-5548

IS - 5

ER -