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Primary aldosteronism with mild autonomous cortisol secretion increases renal complication risk
Takuyuki Katabami1, Ren Matsuba1, Hiroki Kobayashi2
1Division of Metabolism and Endocrinology, Department of Internal Medicine, St. Marianna University Yokohama City Seibu Hospital, Kanagawa, Japan.
European Journal of Endocrinology
|April 5, 2022
Summary
Mild autonomous cortisol secretion (MACS) significantly increases renal complications in primary aldosteronism (PA) patients. Concomitant MACS and higher aldosterone levels in PA heighten the risk of kidney damage.
Area of Science:
- Endocrinology
- Nephrology
- Internal Medicine
Background:
- Primary aldosteronism (PA) is linked to renal impairment.
- Excess cortisol can also cause kidney damage.
- The combined effect of PA and mild autonomous cortisol secretion (MACS) on renal health is understudied.
Purpose of the Study:
- To investigate if co-existing MACS exacerbates renal complications in patients with PA.
- To determine the independent and combined risks of MACS and aldosterone levels for kidney disorders in PA.
Main Methods:
- Retrospective cross-sectional study of 1310 PA patients.
- Stratification into MACS (n=340) and non-MACS (n=970) groups based on 1 mg dexamethasone suppression test (DST).
- Comparison of renal complication prevalence (eGFR, proteinuria) and logistic regression analysis.
Main Results:
- Lowered eGFR and proteinuria were nearly twice as common in the MACS group.
- MACS and plasma aldosterone concentration (PAC) were independent risk factors for renal outcomes.
- PA patients with both MACS and high PAC had a significantly higher risk of renal complications.
Conclusions:
- MACS is an independent risk factor for renal complications in PA.
- The combination of MACS and elevated aldosterone secretion in PA patients substantially increases the risk of kidney disease.
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