Abstract: FR-PO379
Exploring High Prevalence and Comorbidities of Autonomous Cortisol Secretion in Primary Aldosteronism: A Cohort Study and Systematic Review
Session Information
- Hypertension, CVD, and the Kidneys: Epidemiology
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1602 Hypertension and CVD: Clinical
Authors
- Lai, Chun-Fu, National Taiwan University Hospital, Taipei, Taiwan
- Huang, Chieh, National Taiwan University College of Medicine, Taipei, Taipei, Taiwan
- Chang, Li-Yang, National Taiwan University College of Medicine, Taipei, Taipei, Taiwan
- Wu, Vincent, National Taiwan University Hospital, Taipei, Taiwan
Group or Team Name
- Taiwan Primary Aldosteronism Investigators (TAIPAI) Study Group.
Background
Emerging evidence has suggested a significant prevalence of autonomous cortisol secretion (ACS) among patients diagnosed with primary aldosteronism (PA). Recognizing PA with concurrent ACS is challenging and often complicates patient management.
Methods
In the prospectively enrolled Taiwan Primary Aldosteronism Investigators (TAIPAI) cohort, we conducted an evaluation to ascertain the prevalence, characteristics, and comorbidities associated with ACS among 874 patients diagnosed with PA between February 2018 and February 2024. Additionally, we undertook a systematic review and meta-analysis (CRD42023486755), encompassing publications with comprehensive data up to February 1, 2024, to integrate our findings with global studies for comparative analysis.
Results
Within the TAIPAI cohort (mean age 55.1 ± 11.9 years; female, 52%), a notable proportion (19.8%) of PA patients exhibited ACS. Those with ACS tended to be older (59.4 ± 11.8, P< 0.001), have higher aldosterone levels (44.3 ± 31, P= 0.003), lower baseline estimated glomerular filtration rates (87.1 ± 29.6, P< 0.001), higher glycohemoglobin levels (6.2 ± 1, P= 0.019), a greater incidence of adrenal tumors (55.5%, P< 0.001) as detected by computed tomography, and larger adrenal tumor sizes(1.86 ± 0.76, P< 0.001). The pooled prevalence of ACS among PA patients in the TAIPAI cohort and 11 global studies was 22.8% (95% CI: 20.2, 25.6). [Figure] Significantly, ACS correlated with chronic kidney disease [pooled odds ratio (OR)= 2.09; 95% CI: 1.62, 2.7], diabetes mellitus (pooled OR= 1.63; 95% CI: 1.2, 2.2), and cardiovascular disease (pooled OR=1.63; 95% CI: 1.2, 2.2) among PA patients.
Conclusion
ACS prevalence in PA patients is high, exceeding 20%. There are strong associations between ACS and clinical features of advanced age, impaired kidney function, diabetes, cardiovascular disease, and larger adrenal tumors. These findings underscore the need for vigilant monitoring and prompt detection of ACS in PA patients with these comorbidities.
Forest Plot of ACS Prevalence in PA Patients.
Funding
- Government Support – Non-U.S.