Retrospective Cohort Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 26, 2024; 12(18): 3332-3339
Published online Jun 26, 2024. doi: 10.12998/wjcc.v12.i18.3332
Prevalence and impact of diabetes and prediabetes on presentation and complications of primary hyperaldosteronism at diagnosis
Debmalya Sanyal, Pradip Mukhopadhyay, Sujoy Ghosh
Debmalya Sanyal, Department of Endocrinology, NHRTIICS & KPC Medical College, Kolkata 700032, West Bengal, India
Pradip Mukhopadhyay, Department of Endocrinology, IPGME&R and SSKM Hospital, Kolkata 700020, West Bengal, India
Sujoy Ghosh, Department of Endocrinology, IPGME&R, Kolkata 700020, West Bengal, India
Author contributions: Sanyal D conceptualized and conducted the study; Sanyal D and Mukhopadhyay P conducted the data analysis, literature search and developed the manuscript draft; Sanyal D, Mukhopadhyay P and Ghosh S contributed to critically reviewing and revision of the manuscript. All authors have read and approved the final manuscript.
Institutional review board statement: The study has been carried out in accordance with the Institutional Review Board of Ethics (EC Ref No. KNRTIICSEC/INV/Non-Reg/2022/004).
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: The presented data are anonymized and risk of identification is low.
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Debmalya Sanyal, FACE, Professor, Department of Endocrinology, KPC Medical College, 1F, Raja SC Mallick Road, Jadavpur, Kolkata 700032, West Bengal, India. drdebmalyasanyal@gmail.com
Received: December 30, 2023
Revised: February 6, 2024
Accepted: May 8, 2024
Published online: June 26, 2024
Processing time: 170 Days and 17.2 Hours
Abstract
BACKGROUND

Primary hyperaldosteronism (PH) is considered to contribute to increased risk of developing type 2 diabetes mellitus (T2DM) and prediabetes. Both PH and DM are associated with increased risk for hypertension, cardiovascular diseases, and chronic kidney diseases. However, data on prevalence of T2DM and prediabetes in PH, and impact of T2DM and prediabetes on presentation and cardio renal complications in PH at presentation is sparse.

AIM

To determine the prevalence of T2DM and prediabetes in PH at diagnosis and impact on presentation and complications of PH.

METHODS

A retrospective cohort study was conducted in tertiary care settings in individuals with confirmed diagnosis of PH at presentation. Demographic variables, clinical presentations, duration and degree of hypertension, complications, laboratory parameters including sodium, potassium levels, plasma aldosterone concentration (PAC), plasma renin activity (PRA), and aldosterone to renin ratio (ARR) and cardio-renal parameters were collected. Comparison was done between three groups: PH with no DM (Group A) or with pre-diabetes (Group B) or with T2DM (Group C). P < 0.05 was statistically significant.

RESULTS

Among 78 individuals with confirmed PH, 62% had pre-diabetes or diabetes; with 37% having DM. Mean duration of T2DM was 5.97 ± 4.7 years. The mean levels of glycaemic parameters among the group A vs B vs C individuals were fasting plasma glucose (mg/dL): 87.9 ± 6.5, 105.4 ± 9.02, 130.6 ± 21.1; post prandial plasma glucose (mg/dL): 122.7 ± 9.8, 154.9 ± 14, 196.7 ± 38.0; glycated haemoglobin (%) (5.3 ± 0.2, 5.9 ± 0.2, 7.5 ± 0.6, P < 0.05), respectively. There was no significant difference in the biochemical parameters (PAC, PRA, ARR, sodium, potassium levels), presentation and complications between the groups. Cardio renal parameters or degree and duration of hypertension were comparable between the groups.

CONCLUSION

Significant prevalence of T2DM and prediabetes in PH at diagnosis does not impact its presentation or complications. Early screening for undetected PH in T2DM and prediabetes subjects with hypertension may prevent complications.

Keywords: Primary hyperaldosteronism; Diabetes; Prediabetes; Hypertension; Aldosterone; Aldosterone to renin ratio

Core Tip: Current investigation found a high prevalence of type 2 diabetes mellitus (T2DM) and prediabetes in primary hyperaldosteronism (PH) at diagnosis. However glycaemic status did not impact clinical or biochemical profiles, number of antihypertensive medications or complications. Long duration of hypertension, high antihypertensive requirement and hypokalemia with hypertension was the most common presentation, suggesting delayed PH diagnosis irrespective of glycaemic status. Underlying undetected PH can worsen hypertension, glycemia and cardiorenal risk in hypertensive patients with T2DM/prediabetes. Screening and early detection of PH in T2DM/prediabetes subjects with hypertension especially with hypokalemia or resistant hypertension, might help in effective management and preventing complications of hypertension and uncontrolled T2DM.