Poster Presentation ESA-SRB-ANZBMS 2024 in conjunction with ENSA

Insulin resistance across the spectrum of renin-independent aldosteronism (#539)

Hakim Khan 1 , Angeline Ooi 2 , Jennifer Wong 1 , Peter Fuller 1 3 , Jun Yang 1 2 3 , Renata Libianto 1 3
  1. Monash Health, Clayton, VIC
  2. Monash University, Clayton, VIC
  3. Hudson Institute of Medical Research, Clayton, VIC

There is an increasing recognition of a spectrum of renin-independent aldosteronism, with primary aldosteronism (PA) on the severe end and low renin-hypertension (LRH) on the milder end. Dysregulated insulin production or action has been reported in PA but has not been investigated in LRH. Our study aimed to analyse insulin resistance across the spectrum of renin-independent aldosteronism with comparison to EH. We conducted a retrospective cohort study of 172 patients from the Monash Health Endocrine Hypertension clinic who had baseline fasting glucose and insulin data. Patients were screened for PA with the aldosterone to renin ratio, followed by confirmation with a saline suppression test. LRH was diagnosed if renin concentration was < 10 mU/L and the saline suppression test was negative. Insulin sensitivity and resistance were assessed using the quantitative insulin sensitivity check index (QUICKI) and homeostatic model assessment for insulin resistance (HOMA-IR). The cohort included 60 patients with PA, 42 with LRH and 70 with EH. Patients with EH were younger and had higher body mass index (BMI) than the other groups but similar sex distribution. Insulin resistance differed between the groups (HOMA-IR of 2.8 in EH, 2.0 in LRH and 2.0 in PA, p=0.046). This difference was most prominent in patients with BMI >30, although not statistically significant (HOMA-IR 4.1 in EH, 3.0 in LRH, 2.9 in PA, p=0.224). Insulin sensitivity varied in the groups with QUICKI of 0.33, 0.34 and 0.34 respectively (p=0.046). Excluding patients with diabetes had no impact on these HOMA-IR and QUICKI trends across the groups. Insulin resistance and sensitivity did not differ between unilateral and bilateral PA. In conclusion, patients with PA and LRH had similar measures of insulin sensitivity and resistance. The impact of these findings on cardiometabolic risks in patients with LRH remains to be determined.

  1. Adler GK, Murray GR, Turcu AF, Nian H, Yu C, Solorzano CC, et al. Primary Aldosteronism Decreases Insulin Secretion and Increases Insulin Clearance in Humans. Hypertension (Dallas, Tex : 1979), 2020.
  2. Fischer E, Adolf C, Pallauf A, Then C, Bidlingmaier M, Beuschlein F, et al. Aldosterone excess impairs first phase insulin secretion in primary aldosteronism. The Journal of clinical endocrinology and metabolism. 2013;98(6):2513-20.
  3. Catena C, Lapenna R, Baroselli S, Nadalini E, Colussi G, Novello M, Favret G, Melis A, Cavarape A, Sechi LA. Insulin sensitivity in patients with primary aldosteronism: a follow-up study. J Clin Endocrinol Metab. 2006;91:3457–3463. doi: 10.1210/jc.2006-0736
  4. Grewal S, Fosam A, Chalk L, Deven A, Suzuki M, Correa RR, et al. Insulin sensitivity and pancreatic β-cell function in patients with primary aldosteronism. Endocrine. 2021;72(1):96-103.