ECE2023 Poster Presentations Adrenal and Cardiovascular Endocrinology (72 abstracts)
Prevalence of autonomous cortisol secretion in patients with primary aldosteronism and its implications on the cardiometabolic profile and on surgical outcomes
Marta Araujo Castro 1 , Miguel Paja Fano 2 , Begoña Pla Peris 3 , Margarita González Boillos 3 , Eider Pascual-Corrales 4 , Ana García Cano 1 , Paola Parra Ramírez 5 , Patricia Martin Rojas 5 , Jorge Gabriel Ruiz Sánchez 6 , Almudena Vicente 7 , Emilia Gomez Hoyos 8 , Iñigo García Sanz 9 , Rebeca Barahona San Millan 10 , María José Picón César 11 , Patricia Diaz Guardiola 12 , Carolina M. Perdomo 13 , Laura Manjon Miguelez 14 , Ángel Rebollo-Román 15 , María Calatayud 16 , Cristina Lamas 17 , Theodora Michalopoulou Alevras 18,19,19 , María C. Tous Romero 20 , Rogelio García Centeno 21 , Cristina Robles Lázaro 22 , Paola Gracia Gimeno 23 , Miguel Antonio Sampedro Núñez 9 , Elena Mena Ribas 24 , Alicia Sanmartín Sánchez 24 , Joaquin Serrano 25 , Eva María Moya Mateo 26 , Verónica Escudero Quesada24 27 & Felicia Alexandra Hanzu 28
1Ramón y Cajal Hospital, Madrid, Spain; 2Basurto University Hospital, Bilbo, Spain; 3Hospital General Universitari de Castelló, Castelló de la Plana, Spain; 4Ramón y Cajal, Madrid, Spain; 5La Paz University Hospital, Madrid, Spain; 6Fundación Jiménez Diaz, Madrid, Spain; 7Hospital General Universitario de Toledo, Toledo, Spain; 8University Clinical Hospital of Valladolid, Valladolid, Spain; 9Hospital de La Princesa, Madrid, Spain; 10Institut Català de la Salut, Tortosa, Spain; 11Hospital Universitario Virgen de la Victoria, Málaga, Spain; 12Infanta Sofia University Hospital, San Sebastián de los Reyes, Spain; 13Clinica Universidad de Navarra, Pamplona, Spain; 14Central University Hospital of Asturias, Oviedo, Spain; 15Hospital Reina Sofía, Córdoba, Spain; 16University Hospital October 12, Madrid, Spain; 17Hospital, Albacete, Spain; 18Hospital Universitari Joan XXIII, Endocrinology and Nutrition, Tarragona, Spain; 19Universitat Rovira i Virgili, Tarragona, Spain; 20hospital universitario virgen macarena, Sevilla, Spain; 21Hospital Gregorio Marañón, Madrid, Spain; 22Salamanca University Hospital, Salamanca, Spain; 23Hospital Royo Villanova, Zaragoza, Spain; 24Hospital Universitari Son Espases, Palma, Spain; 25General University Hospital of Alicantet, Alacant, Spain; 26Hospital Universitario Infanta Leonor, Madrid, Spain; 27Hospital Dr. Peset, València, Spain; 28Hospital Clínic de Barcelona, Barcelona, Spain
Purpose: To evaluate the prevalence of autonomous cortisol secretion (ACS) in patients with primary aldosteronism (PA) and its implications on cardiometabolic and surgical outcomes.
Methods: A retrospective multicenter study of PA patients who underwent 1mg-dexamethasone suppression test (DST) in follow-up in 21 Spanish tertiary hospitals. ACS was defined as a cortisol post-DST >1.8μg/dL (confirmed ACS if >5μg/dL and possible ACS if between 1.8-5μg/dL) in absence of specific clinical features of hypercortisolism. A control group with ACS without PA (ACS group) matched by age and DST levels was included for comparing the cardiometabolic profile with the ACS-PA group.
Results: The prevalence of ACS-PA in the global cohort of patients with PA (n=176) was 29.0% (n=51). Ten patients had confirmed ACS and 41 possible ACS. The cardiometabolic profile of patients with ACS-PA and PA was similar, except for an older age (59.3±11.22 vs. 55.5±11.87 years, P=0.049) and a larger tumor size of the adrenal lesion (24.4±14.01 vs. 17.3±6.84mm, P<0.001) in the ACS-PA group. Additionally, as it would be expected, cortisol post-DST were higher (4.1±4.20 vs. 1.1±0.40μg/dL, P<0.001) and ACTH levels lower (15.0±10.97 vs. 20.2±10.55 pg/mL, P=0.030) in ACS-PA patients than in the 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 of cardiovascular events (OR 5.0 [2.29-11.07]) was higher in ACS-PA patients than in ACS patients. However, patients with isolated ACS presented greater levels of HbA1c than ACS-PA patients (5.8±0.82 vs. 6.5±1.47%, P=0.024). Of the 176 patients of the PA cohort, 59 underwent adrenalectomy: 20 of the ACS-PA group and 39 of the PA group. Biochemical cure was reached in 94.9%, hypertension cure in 37.3% and hypertension improvement in 54.3%. The coexistence of ACS in patients with PA (ACS-PA) did not affect the surgical outcomes, being the proportion of biochemical and clinical cure similar between ACS-PA and PA groups (100% vs. 92.3%, P=0.203 and 45.0% vs. 33.3%, P=0.380, respectively). When compared patients with ACS-PA who underwent adrenalectomy (n=20) and those medically treated (n=31), no differences in the evolution of the cardiometabolic profile was detected between both groups, but surgery led to a greater increase in serum potassium levels.
Conclusion: Co-secretion of cortisol and aldosterone affects a third part of patients with PA. Its presence is more common in patients with larger tumors and an older age. However, the cardiometabolic and surgical outcomes of patients with ACS-PA and PA are similar.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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