Impact of obesity on clinical characteristics of Primary Aldosteronism patients at diagnosis and post-surgical response
Jorge Gabriel Ruiz-Sánchez 1 , Miguel Paja-Fano 2 , Marga González Boillos 3 , Begoña Pla Peris 3 , Eider Pascual-Corrales 4 , Ana María García Cano 5 , Paola Parra Ramírez 6 , Patricia Martín Rojas-Marcos 6 , Almudena Vicente Delgado 7 , Emilia Gómez Hoyos 8 , Rui Ferreira 9 , Iñigo García Sanz 10 , Monica Recasens Sala 11 , Rebeca Barahona San Millan 11 , María José Picón César 12 , Patricia Díaz Guardiola 13 , Juan Jesús García González 14 , Carolina M Perdomo 15 , Laura Manjón Miguélez 16 , Rogelio García Centeno 17 , Juan Carlos Percovich 17 , Ángel Rebollo Román 18 , Paola Gracia Gimeno 19 , Cristina Robles Lázaro 20 , Manuel Morales-Ruiz 21 , Felicia A Hanzu 22 , Marta Araujo-Castro 4 23
Background: Patients with obesity have an overactivated renin-angiotensin-aldosterone system (RAAS) that is associated with essential hypertension. However, the influence of obesity in primary aldosteronism (PA) is unknown. We analyzed the impact of obesity on the characteristics of PA, and the association between obesity and RAAS components.
Methods: Retrospective study of the Spanish PA Registry (SPAIN-ALDO Registry), which included patients with PA seen at 20 tertiary centers between 2018-2022. Differences between patients with and without obesity were analyzed.
Results: 415 patients were included; 189 (45.5%) with obesity. Median age: 55 years [47.3-65.2] and 240 (58.4%) were male. Compared to those without obesity, patients with obesity had higher rates of diabetes mellitus, chronic kidney disease, obstructive apnea syndrome, left ventricular hypertrophy, prior cardiovascular events, higher means of systolic blood pressure (BP) and required more antihypertensive drugs. Patients with PA and obesity also had higher values of serum glucose, HbA1c, creatinine, uric acid, and triglycerides, and lower levels of HDL-cholesterol. Levels of blood aldosterone (PAC) and renin were similar between patients with and without obesity. Body mass index was not correlated with PAC nor renin. The rates of adrenal lesions on imaging studies, as well as the rates of unilateral disease assessed by adrenal vein sampling or I-6β-iodomethyl-19-norcholesterol scintigraphy were similar between groups.
Conclusion: Obesity in PA patients involves a worse cardiometabolic profile, and need for more antihypertensive drugs but similar PAC and renin levels, and rates of adrenal lesions and lateral disease than patients without obesity. However, obesity implicates a lower rate of hypertension cure after adrenalectomy.
CITA DEL ARTÍCULO J Clin Endocrinol Metab. 2023 Jul 10;dgad400. doi: 10.1210/clinem/dgad400