What is the clinical evidence from this study?

Study design: Cohort. Population: Primary aldosteronism (n=396). Intervention: Surgical or medical treatment (spironolactone) vs. Essential hypertension and normotensive subjects. Primary outcome: Short- and long-term changes in glucose tolerance and insulin sensitivity.

What does this research mean for the field?

Treatment of primary aldosteronism with surgery or aldosterone antagonists rapidly and persistently restores normal insulin sensitivity, which is initially impaired compared to normotensive controls. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

July 6, 2006Open Access

Insulin Sensitivity in Patients with Primary Aldosteronism: A Follow-Up Study

Key Result

Treatment of primary aldosteronism with surgery or aldosterone antagonists rapidly and persistently restored normal insulin sensitivity, which was initially lower than in normotensive controls (P<0.01).

Study Design

Type

Cohort (n=396)

Multicenter

Structured PICO

Does treatment of primary aldosteronism with surgery or aldosterone antagonists improve insulin sensitivity compared to essential hypertension and normotensive controls?

Population

396 subjects: 47 patients with tumoral or idiopathic primary aldosteronism, 247 patients with essential hypertension (matched for severity and duration of disease), and 102 normotensive subjects.

Intervention

Surgical (adrenalectomy) or medical treatment (spironolactone) for primary aldosteronism

Comparator

Patients with essential hypertension and normotensive subjects

Outcome

Short- and long-term changes in glucose tolerance and insulin sensitivitysurrogate

Treatment of primary aldosteronism with surgery or aldosterone antagonists rapidly and persistently restores normal insulin sensitivity, which is impaired at baseline.

Abstract

CONTEXT: The relationship between aldosterone and glucose metabolism is poorly understood, and there is substantial disparity among findings of studies that have examined glucose tolerance and insulin sensitivity in patients with primary aldosteronism. OBJECTIVE: The objective of the study was to determine the outcome of glucose tolerance and insulin sensitivity in patients with primary aldosteronism after treatment. DESIGN: This was a prospective study of patients who received a diagnosis of primary aldosteronism and were followed up for an average period of 5.7 yr (range, 3-9 yr). SETTING: The study was conducted at a university referral center. PATIENTS: A consecutive sample of 47 patients with tumoral or idiopathic aldosteronism was followed up after either surgical or medical treatment. Patients with primary aldosteronism were compared with 247 patients with essential hypertension with the same severity and duration of disease and 102 normotensive subjects. MAIN OUTCOME MEASURES: Short- and long-term changes in glucose tolerance and insulin sensitivity were measured. RESULTS: After adjustment for age, gender, and body mass index, patients with primary aldosteronism had greater homeostasis model assessment index (P < 0.05) and plasma insulin response to an oral glucose load (P < 0.05) and lower quantitative insulin sensitivity check index (P < 0.01) than normotensive controls. Changes in insulin sensitivity were significantly greater in essential hypertension than primary aldosteronism, and this difference was confirmed by assessment with the hyperinsulinemic-euglycemic clamp (P < 0.01). Treatment of primary aldosteronism decreased blood pressure significantly, and during the initial 6 months of follow-up, parameters of insulin sensitivity were restored to normal. Analysis of subsequent follow-up showed nonsignificant changes in glucose metabolism parameters in both adrenalectomized and spironolactone-treated patients. CONCLUSIONS: Insulin resistance is present in patients with tumoral and idiopathic aldosteronism, but the defect appears less severe than in patients with essential hypertension. Treatment with surgery or aldosterone antagonists restores rapidly and persistently normal sensitivity to insulin.