新發糖尿病與原發性醛固酮症併發自主皮質醇分泌相關

謝宗頤¹、吳允升²、彭康詠³、詹傑凱⁵、林彥宏⁴、闕士傑¹

¹國立台灣大學醫學院附設醫院 泌尿部，³內科部 ²腎臟科，⁴心臟科; ⁵國立臺灣大學醫學院附設醫院新竹臺大分院 內科部 腎臟科

New-onset Diabetic Mellitus Associated with Concurrent Autonomous Cortisol Secretion in Patients with Primary Aldosteronism

Tsung-Yi Hsieh¹, Vin-Cent Wu², Kang-Yung Peng³, Chieh-Kai Chan⁵, Yen-Hung Lin⁴, Jeff S Chueh¹

¹Department of Urology, ²Division of Nephrology and ⁴Cardiology, ³Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; ⁵Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu City, Taiwan

Purpose: Concurrent autonomous cortisol secretion in patients with primary aldosteronism (PA) is not uncommon. However, its effect on new-onset diabetes mellitus (NODM) has not been previously reported. We investigate the effect of cortisol levels on NODM in PA patients.

Materials and Methods: Using the prospectively designed observational TAIPAI cohort, a total of 476 PA cases from June, 2014 to June, 2018 were identified. The PA patients received an overnight low-dose dexamethasone suppresion test (1 mg DST) and were then grouped by cortisol levels.

Results: We identified 387 patients among 476 newly diagnosed PA patients (43.7% men; mean age 52.8 years) without baseline diabetes mellitus during the study period. After a mean follow-up of 4.3±2.9 years, there were 32 patients (8.3%) identified with NODM. The cut-off value via the generalized additive model showed that a serum cortisol level after 1 mg DST of ≥ 2.65 µg/dL was a risk factor for developing NODM (HR, 2.35, 95% confidence interval, 1.01-5.45, p= 0.047). In PA patients with high body mass index (HR, 3.16), low estimated glomerular filtration rate (HR, 3.18), longer hypertension duration (HR, 3.34), higher waist-to-hip ratio (HR, 3.07), and concomitant serum cortisol level after 1mg DST≥ 2.65 μg/dL, the risks of having NODM was increased.

Conclusions: We showed unprecedentedly that PA patients with concomitant ACS (cortisol ≥ 2.65 µg/dL after 1mg DST) have a higher risk of NODM. Such PA patients should be evaluated and managed with higher awareness to achieve ideal glucose control and prevent potential complications.