Endocrine Abstracts

JOINT3258

Introduction: Primary aldosteronism (PA) is the most common cause of secondary hypertension and a known risk factor for cardiovascular and metabolic disease (1). It may be associated with autonomous co-secretion of cortisol, which may represent an additional risk factor for the development of cardiovascular and possibly metabolic complications (2).

Materials and methods: We searched the database of patients with PA who underwent adrenal vein sampling (AVS) at the University Hospital Centre Zagreb between 2016 and 2024. The total of 140 patients were divided into two groups: patients with mild autonomous cortisol secretion (MACS) and those with normal cortisol in the overnight dexamethasone suppression test (ODST) or cortisol in 24-hour urine. MACS was defined as a cortisol finding in the ODST > 50 nmol/L or a cortisol finding in the 24-hour urine > 416 nmol. Of the total number of patients, 16% had MACS. We compared whether there was a statistically significant difference in metabolic parameters or cardiovascular outcomes in the two patient groups.

Results: Univariate analysis showed that there was a statistically significant difference between patients with MACS and those without MACS in the value of eGFR (89 vs. 95 ml/min per 1.73 m², P=0.013), in the use of hypolipemic medications (43% of patients with MACS vs. 18% of patients without MACS, P=0.007) and in the occurrence of cerebrovascular disease (9% of patients with MACS vs. 0.9% of patients without MACS, P=0.018). A possible association with albuminuria was observed but needs to be further validated (57% of patients with MACS vs. 32% of patients without MACS, P=0.073). No significant differences in metabolic parameters or other cardiovascular outcomes were observed. In a binary logistic regression analysis after adjustment for age, cerebrovascular disease and lipid-lowering medication use, only lipid-lowering medication use was an independent predictor of MACS (P=0.03, OR 0.331, 95% CI 0.121–0.902).

Conclusions: MACS is associated with an increased incidence of cerebrovascular adverse events in patients with PA, while an increased incidence of albuminuria cannot be excluded either, which should be verified in a larger patient population.

References(1) Otsuka H, Abe M, Kobayashi H. The effect of aldosterone on the cardiorenal and metabolic systems. Int J Mol Sci. 2023 Mar 11;24(6):5370.

(2) Nakajima Y, Yamada M, Taguchi R, Satoh T, Hashimoto K, Ozawa A, Shibusawa N, Okada S, Monden T, Mori M. Cardiovascular complications of patients with aldosteronism associated with autonomous cortisol secretion. J Clin Endocrinol Metab. 2011 Aug;96(8):2512–8.