Cardiovascular Complications of Patients with Aldosteronism Associated with Autonomous Cortisol Secretion

Context: Primary aldosteronism (PA) is sometimes associated with the autonomous secretion of cortisol. Objective: Our objective was to investigate the effect of autonomous cortisol secretion on the prevalence of cardiovascular events (CVE) in patients with PA. Design: This was a retrospective cross-sectional study of cases collected from Gunma University Hospital between 2002 and 2010. Patients: Seventy-six consecutive patients hospitalized for an evaluation of PA were analyzed. Main Outcome Measures: Rates of CVE dependent on autonomous cortisol secretion were examined. Results: Of the 76 patients with PA, 21 (28%) had a history of CVE, including 14 with stroke, one with myocardial infarction, and six with atrial fibrillation. The multivariate logistic-regression and receiver operating characteristic analyses revealed that PA patients with CVE had significantly higher midnight cortisol levels than those without CVE; the adjusted odds ratio with a cutoff value of 7.4 mu g/dl was 7.0 (95% confidence interval, 1.8-30.6; P = 0.006). In addition, results of the 1-mg dexamethasone suppression test with a cutoff value of 3.0 mu g/dl differed significantly (odds ratio, 5.0; 95% confidence interval, 1.4-20.7; P = 0.018). Conversely, 67 and 50% of the PA patients with a midnight cortisol level of at least 7.4 mu g/dl and 1-mg dexamethasone suppression test of at least 3.0 mu g/dl had a history of CVE. Other factors such as age, expected glomerular filtration rate, blood pressure, glucose intolerance, the serum aldosterone concentration, plasma renin activity, and the duration of hypertension had no effect. Conclusion: The patients with PA associated with autonomous cortisol secretion had high incidence of CVE, and this association may further increase the risk of CVE in patients with PA. (J Clin Endocrinol Metab 96: 2512-2518, 2011)