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Araujo-Castro M, Paja Fano M, Pla Peris B, González Boillos M, Pascual-Corrales E, García-Cano AM, Parra Ramírez P, Rojas-Marcos PM, Ruiz-Sanchez JG, Vicente A, Gómez-Hoyos E, Ferreira R, García Sanz I, Recasens M, Barahona San Millan R, Picón César MJ, Díaz Guardiola P, Perdomo C, Manjón L, García-Centeno R, Percovich JC, Rebollo Román Á, Gracia Gimeno P, Robles Lázaro C, Morales M, Calatayud M, Collao SAF, Meneses D, Sampedro Nuñez MA, Escudero Quesada V, Ribas EM, Sanmartín Sánchez A, Diaz CG, Lamas C, Guerrero-Vázquez R, del Castillo Tous M, Serrano J, Michalopoulou T, Moya Mateo EM, Hanzu F. Autonomous cortisol secretion in patients with primary aldosteronism: prevalence and implications on cardiometabolic profile and on surgical outcomes. Endocr Connect 2023; 12:e230043. [PMID: 37410097 PMCID: PMC10448600 DOI: 10.1530/ec-23-0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 07/04/2023] [Indexed: 07/07/2023]
Abstract
Purpose 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. Methods 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. Results 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. Conclusion 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.
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Affiliation(s)
- Marta Araujo-Castro
- Department of Endocrinology & Nutrition, Hospital Universitario Ramón y Cajal & Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Madrid, Spain
- University of Alcalá, Madrid, Spain
| | - Miguel Paja Fano
- Department of Endocrinology & Nutrition, OSI Bilbao-Basurto, Hospital Universitario de Basurton & Basque Country University, Medicine Department, Bilbao, Spain
| | - Begoña Pla Peris
- Department of Endocrinology & Nutrition, Hospital Universitario de Castellón, Castellón, Spain
| | - Marga González Boillos
- Department of Endocrinology & Nutrition, Hospital Universitario de Castellón, Castellón, Spain
| | - Eider Pascual-Corrales
- Department of Endocrinology & Nutrition, Hospital Universitario Ramón y Cajal & Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Madrid, Spain
| | | | - Paola Parra Ramírez
- Department of Endocrinology & Nutrition, Hospital Universitario La Paz Madrid, Spain
| | | | | | - Almudena Vicente
- Department of Endocrinology & Nutrition, Hospital Universitario de Toledo, Toledo, Spain
| | - Emilia Gómez-Hoyos
- Department of Endocrinology & Nutrition, Hospital Universitario de Valladolid, Valladolid, Spain
| | - Rui Ferreira
- Department of Endocrinology & Nutrition, Hospital Universitario Rey Juan Carlos, Madrid, Spain
| | - Iñigo García Sanz
- Department of General & Digestive Surgery, Hospital Universitario de La Princesa, Madrid, Spain
| | - Mónica Recasens
- Department of Endocrinology & Nutrition, Institut Català de la Salut Girona, Girona, Spain
| | | | - María José Picón César
- Department of Endocrinology & Nutrition, Hospital Universitario Virgen de la Victoria de Málaga, IBIMA Malaga, Spain CIBEROBN, Madrid, Spain
| | - Patricia Díaz Guardiola
- Department of Endocrinology & Nutrition, Hospital Universitario Infanta Sofía, Madrid, Spain
| | - Carolina Perdomo
- Department of Endocrinology & Nutrition, Clínica Universidad de Navarra, Pamplona, Spain
| | - Laura Manjón
- Department of Endocrinology & Nutrition, Hospital Universitario Central de Asturias & Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Rogelio García-Centeno
- Department of Endocrinology & Nutrition, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Juan Carlos Percovich
- Department of Endocrinology & Nutrition, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Ángel Rebollo Román
- Department of Endocrinology & Nutrition, Hospital Reina Sofía, Córdoba, Spain
| | - Paola Gracia Gimeno
- Department of Endocrinology & Nutrition, Hospital Rollo Villanova, Zaragoza, Spain
| | - Cristina Robles Lázaro
- Department of Endocrinology & Nutrition, Complejo Universitario de Salamanca, Salamanca, Spain
| | - Manuel Morales
- Biochemistry and Molecular Genetics Department-CDB, Hospital Clinic, IDIBAPS, CIBERehd, Barcelona, Spain
| | - María Calatayud
- Department of Endocrinology & Nutrition, Hospital Doce de Octubre, Madrid, Spain
| | | | - Diego Meneses
- Department of Endocrinology & Nutrition, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | | | | | - Elena Mena Ribas
- Department of Endocrinology & Nutrition, Hospital Universitario Son Espases, Islas Baleares, Spain
| | - Alicia Sanmartín Sánchez
- Department of Endocrinology & Nutrition, Hospital Universitario Son Espases, Islas Baleares, Spain
| | - Cesar Gonzalvo Diaz
- Department of Endocrinology & Nutrition, Hospital Universitario De Albacete, Albacete, Spain
| | - Cristina Lamas
- Department of Endocrinology & Nutrition, Hospital Universitario De Albacete, Albacete, Spain
| | | | | | - Joaquín Serrano
- Department of Endocrinology & Nutrition, Hospital General Universitario de Alicante, Alicante, Spain
| | - Theodora Michalopoulou
- Department of Endocrinology and Nutrition, Joan XXIII University Hospital, Tarragona, Spain
| | | | - Felicia Hanzu
- Department of Endocrinology & Nutrition, Hospital Clinic, IDIPAS, Barcelona, Spain
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