ECE2016 Eposter Presentations Adrenal cortex (to include Cushing's) (85 abstracts)
Paradoxical worsening of lipid metabolism after successful treatment of primary aldosteronism
Christian Adolf 1 , Evelyn Asbach 1 , Anna Dietz 1 , Stefanie Hahner 2 , Marcus Quinkler 3 , Lars Christian Rump 4 , Martin Bidlingmaier 1 , Marcus Treitl 1 , Klaus Hallfeldt 5 , Felix Beuschlein 1 & Martin Reincke 1
1Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität, München, Germany; 2Medizinische Klinik I, Julius-Maximilians-Universität, Würzburg, Germany; 3Endokrinologiepraxis in Charlottenburg, Berlin, Germany; 4Klinik für Nephrologie, Heinrich Heine Universität, Düsseldorf, Germany; 5Klinik für Viszeral- und Endokrine Chirurgie, Klinikum der Ludwig-Maximilians-Universität, München, Germany.
Primary aldosteronism (PA) describes the most frequent cause of secondary arterial hypertension. Aldosterone itself represents a BP-independent cardiovascular risk factor associated with increased rates of morbidity and mortality. Recently a worsening of lipid metabolism after treatment has been described.
Objective: Our aim was to analyse changes in lipid parameters according to treatment outcome in PA patients. Data of 215 consecutive PA patients with unilateral aldosterone-producing adenoma (APA, n=144) or bilateral idiopathic adrenal hyperplasia (IHA, n=71) were extracted from the database of the German Conn’s Registry.
To assess the metabolic outcome, they were investigated before, one year and three years after treatment by adrenalectomy (ADX) or by MR-antagonist (MRA).
Results: One year after initiation of treatment potassium had been normalized in all patients. High-density lipoprotein cholesterol (HDL-C) and triglycerides (TG) changed inversely. HDL-C was significantly lower in patients with APA (53.00 (45.3; 67) vs 52.00 (44; 65) mg/dl, P=0.046) and IHA (52.00 (42; 66) vs 48.00 (39; 62) mg/dl, P=0.004) after treatment. TG were significantly higher in both subgroups at follow-up (APA 103.5 (69.3; 148.0) vs 111.0 (78.3; 166.5) mg/dl, P=0.000; IHA 111.0 (82; 150) vs 129.0 (85; 195) mg/dl, P=0.020), whereas BMI remained unchanged and fasting plasma glucose (FPG) even improved in follow-up patients with APA (99.0 (90; 109) vs 95.0 (88; 104) mg/dl, P=0.004).
Changes in the HDL-C-to-TG ratio at one year follow-up correlated with decrease of GFR (β=0.184, P=0.024) in multivariate analysis but not with change in potassium, urea or urine albumin-to-creatinine ratio (ACR). After two more years there was a slight further decline in GFR (P=0.012), whereas HDL-C remained stable.
Conclusion: Our results show that treatment of PA is associated with a worsening of lipid parameters despite improved glucose parameters and stable BMI. This paradoxical effect could be explained by renal dysfunction following ADX or MRA treatment caused by a decrease in glomerular hyperfiltration. In view of stable low-density lipoprotein cholesterol, reduced albuminuria, FPG and blood pressure, however, a higher risk for atherosclerosis in patients with PA after treatment seems unlikely.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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