Aldosterone excess may inhibit insulin secretion: A comparative study on glucose metabolism pre- and post-adrenalectomy in patients with primary aldosteronism
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- Tsurutani Yuya
- Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Yokohama 222-0036, Japan
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- Sugisawa Chiho
- Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Yokohama 222-0036, Japan Division of Diabetes, Metabolism and Endocrinology, Showa University Fujigaoka Hospital, Yokohama 227-8501, Japan
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- Ishida Akiko
- Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Yokohama 222-0036, Japan
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- Inoue Kosuke
- Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Yokohama 222-0036, Japan
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- Saito Jun
- Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Yokohama 222-0036, Japan
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- Omura Masao
- Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Yokohama 222-0036, Japan
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- Nagasaka Shoichiro
- Division of Diabetes, Metabolism and Endocrinology, Showa University Fujigaoka Hospital, Yokohama 227-8501, Japan
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- Nishikawa Tetsuo
- Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Yokohama 222-0036, Japan
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抄録
Conflicting data have been published on the effects of aldosterone excess on glucose metabolism. Specifically, there are limited data on whether adrenalectomy in patients with aldosterone-producing adenomas (APA) can improve glucose metabolism. In this study we evaluated changes in glucose metabolism, before and after surgery for APA. The subjects were 61 patients treated with unilateral adrenalectomy, localized by adrenal venous sampling. A 75g-oral glucose tolerance test (OGTT) was performed before and 1 year after adrenalectomy. Patients with diabetes mellitus or a serum cortisol level >3 μg/dL after a 1 mg dexamethasone suppression test, were excluded. Using the 75g-OGTT data, insulin secretion and insulin resistance (or sensitivity) indices were calculated. The results showed that immunoreactive insulin levels during the OGTT increased significantly after adrenalectomy, whereas plasma glucose levels, before and after surgery, were comparable. The insulinogenic index significantly increased after surgery (0.5 [0.4-0.8] to 0.8 [0.4-1.1], p < 0.001). The disposition index remained largely unchanged (806.2 [489.4-1,138.9] to 686.6 [479.4-922.1], p = 0.25). The homeostatic model assessment of insulin resistance increased significantly (1.0 [0.6-1.5] to 1.5 [1.0-2.2], p < 0.001) and the ISImatsuda decreased significantly (6.9 [4.5-10.4] to 5.2 [3.4-7.9], p < 0.001). Changes in these indices were not correlated with changes in potassium and aldosterone levels before and after surgery. In conclusion, insulin secretion increased after adrenalectomy for APA, indicating that aldosterone excess inhibits insulin secretion. However, because of a parallel increase in insulin resistance, plasma glucose levels remained unchanged.
収録刊行物
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- Endocrine Journal
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Endocrine Journal 64 (3), 339-346, 2017
一般社団法人 日本内分泌学会
