Adrenalectomy reduces risk of new-onset diabetes mellitus, all-cause mortality
Patients with primary aldosteronism who underwent adrenalectomy have lower risk of incident new-onset diabetes mellitus (NODM) and all-cause mortality than matched hypertensive controls, according to a recent study.
Researchers identified patients diagnosed with primary aldosteronism and essential hypertension. They then used a validated algorithm from a 23-million population insurance registry to ascertain the occurrence of NODM and all-cause mortality among the participants.
A total of 2,367 primary aldosteronism patients without previous DM were identified and propensity score-matched with 9,468 patients with essential hypertension from 1999 to 2007. Among primary aldosteronism patients, 754 who had aldosterone-producing adenomas were identified and matched with 3,016 essential hypertension controls.
Compared with essential hypertension controls, primary aldosteronism patients who underwent adrenalectomy had reduced incidence of NODM (hazard ratio [HR], 0.60; p<0.01), while those treated with mineralocorticoid receptor antagonist had increased risk of NODM (HR, 1.16; p<0.001) over a mean follow-up of 5.2 years.
Furthermore, adrenalectomy was protective against the development of NODM among aldosterone-producing adenoma patients (HR, 0.61; p<0.001), but treatment with mineralocorticoid receptor antagonist did not alter the risk of NODM (p=0.10).
Adjusted HRs for long-term risk of mortality from this analysis demonstrated that adrenalectomy was protective but NODM and major cardiovascular disease were harmful.
“This observation adds more evidence on the association of primary aldosteronism with a higher risk of metabolic syndrome and long-term mortality,” researchers said, adding that abnormal glucose metabolism due to insulin resistance has been linked to overproduction of aldosterone.