The Metabolic Syndrome in Primary Aldosteronism

Patients with hypertension have a high prevalence of concurrent metabolic abnormalities (eg, obesity, dyslipidemia, and hyperglycemia). Clustering of these risk factors, defined as the metabolic syndrome, is associated with a high cardiovascular risk profile. This review summarizes current knowledge about the prevalence and characteristics of the metabolic syndrome in primary aldosteronism, and discusses the possible pathophysiological link between aldosterone and individual components of the metabolic syndrome, other than hypertension. Impaired glucose metabolism due to insulin resistance appears to be the major contributor to metabolic dysfunction in primary aldosteronism. Experimental observations support the possibility that aldosterone could act directly on insulin receptor function. The potential proadipogenic role of aldosterone and its negative effect on insulin sensitivity through production of cytokines remains to be investigated. Higher rates of cardiovascular events reported in primary aldosteronism could be due in part to the increased prevalence of the metabolic syndrome in this disorder.