Insulin sensitivity and pancreatic β-cell function in patients with primary aldosteronism

• Published in: Endocrine Vol. 72; no. 1; pp. 96 - 103
• Main Authors: Grewal, Shivraj, Fosam, Andin, Chalk, Liam, Deven, Arjun, Suzuki, Mari, Correa, Ricardo Rafael, Blau, Jenny E., Demidowich, Andrew Paul, Stratakis, Constantine A., Muniyappa, Ranganath
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.04.2021; Springer Nature B.V
• Subjects: Aldosterone; Beta cells; Blood Glucose; Blood pressure; Chromium; Cross-Sectional Studies; Diabetes; Endocrine disorders; Endocrinology; Glucose tolerance; Glucose Tolerance Test; Humanities and Social Sciences; Humans; Hyperaldosteronism; Insulin; Insulin Resistance; Insulin-Secreting Cells; Internal Medicine; Medicine; Medicine & Public Health; multidisciplinary; Original Article; Pancreas; Science; Steroid hormones; Essential hypertension; β-cell function; Primary aldosteronism; Insulin sensitivity
• ISSN: 1355-008X; 1559-0100
• DOI: 10.1007/s12020-020-02576-y

Background Primary aldosteronism (PA) is associated with an increased risk for dysglycemia. However, the effects of hyperaldosteronism on insulin sensitivity and β-cell function are unclear. Methods Using a cross-sectional study design, we assessed insulin sensitivity and pancreatic β-cell function from an oral glucose tolerance test (OGTT) in patients from two cohorts: subjects with PA ( n  = 21) and essential hypertension control (EHC) subjects ( n  = 22). Age, sex, BMI, and mean arterial pressure adjusted measures of insulin sensitivity and β-cell function were compared between the groups. Results PA individuals were less insulin sensitive compared to EHC subjects (Quantitative insulin sensitivity check index [QUICKI]: 0.340 ± 0.006 vs. 0.374 ± 0.013, p  < 0.001; Matsuda index: 4.14 ± 0.49 vs. 7.87 ± 1.42, p  < 0.001; S I : 11.45 ± 4.85 vs. 21.23 ± 6.11 dL/kg/min per μU/mL, p  = 0.02). The hepatic insulin resistance index (HIRI) was higher in PA subjects (PA: 5.61 ± 1.01 vs. EHC: 4.13 ± 0.61, p  = 0.002). The insulinogenic index (IGI), an index of β-cell function was higher in the PA cohort (PA: 1.49 ± 0.27 vs. 1.11 ± 0.21 μU/mL/mg/dL, p  = 0.03). However, the oral disposition index (DI) was similar between the groups (PA: 4.77 ± 0.73 vs. EHC: 5.46 ± 0.85, p  = 0.42), which likely accounts for the similar glucose tolerance between the two cohorts, despite lower sensitivity. Conclusions In summary, insulin sensitivity is significantly lower in PA with an appropriately compensated β-cell function. These results suggest that excess aldosterone and/or other steroids in the context of PA may negatively affect insulin action without adversely impacting β-cell function.