New Exploration Of Subtype Diagnosis And Metabolism In Primary Aldosteronism

[BACKGROUND]Aldosterone-producing adenoma(APA)and idiopathic hyperaldosteronism(IHA)are the most frequent subtypes of primaryary aldosteronism(PA).Adrenal venous sampling(AVS)has been established as the gold standard to confirm lateralization,but this approach is invasive and technically challenging.Therefore,it is important to optimize the indication for IHA,thus decreasing the number of candidates for AVS.Up to date.Clinical studies present disparity among findings that have examined the relationship between aldosterone and glucose,lipid metabolism in PA and essential hypertension(EH).A further study is needed to explore the relationship.?AIM?This study aimed to develop a novel model for subtype diagnosis in PA patients and explore the relationship between plasma aldosterone concentration(PAC)and glucose,lipid metabolism.?METHOD?1.264 patients were randomly divided into a training set(n=185)and a validation set(n=79).Risk factors for IHA differentiating from APA were identified using logistic regression analysis.A nomogram was constructed to predict the probability of IHA.Receiver operating characteristic(ROC)curve and calibration plot were applied to assess the predictive value.Then 115 patients were prospectively enrolled,and the nomogram was used to predict the subtypes before AVS.2.We retrospectively enrolled 797 PA patients and 989 EH.We divided patients with PA and EH into quartiles according to PAC.We analysed the relationship between PAC and glucose and lipid metabolism.Then we analysed the changes of glucose and lipid metabolism before and after adrenalectomy in the 243 PA patients with follow-ups.?RESULT?1.Body mass index(BMI),serum potassium and adrenal computed tomography(CT)finding were adopted in the nomogram.The nomogram presented an area under the ROC(AUC)of 0.924(95% CI 0.875-0.957),sensitivity of 86.59% and specificity of 87.38% in the training set and an AUC of 0.894(95% CI 0.804-0.952),sensitivity of 82.86% and specificity of 84.09% in the validation set.Using the nomogram to predict IHA in the prospective set before AVS,the specificity reached 100% if we increased the threshold to a probability of 90%.2.PA patients had lower fasting glucose,fasting insulin,triglycerides,total cholesterol and low-density lipoprotein cholesterol than EH(p<0.001).We observed significantly decreased plasma insulin levels(p=0.003),decreased triglycerides(p=0.006),and decreased prevalence of hypertriglyceridemia(p=0.032)across PAC quartiles.243 APA underwent adrenalectomy.Patients presented improvement in blood pressure,serum potassium and PAC(p<0.001)in the follow-ups.Besides,patients presented elevated triglycerides,total cholesterol and low-density lipoprotein cholesterol after adrenalectomy(p<0.001).The prevalence of hypertriglyceridemia increased after adrenalectomy(p<0.001).However,no similar trends were found in EH.?CONCLUSION?1.A novel model based on BMI,serum potassium ans adrenal CT findings was developed that was able to predict IHA in patients with PA and potentially avoid AVS.This model allows omitting unnecessary expensive and invasive work-up.2.In patients with PA,PAC may inhibit the secreation of insulin and had inverse association with triglycerides.However,no similar trends were found in essential hypertension.