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Insulin sensitivity and pancreatic β-cell function in patients with primary aldosteronism

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Abstract

Background

Primary aldosteronism (PA) is associated with an increased risk for dysglycemia. However, the effects of hyperaldosteronism on insulin sensitivity and β-cell function are unclear.

Methods

Using a cross-sectional study design, we assessed insulin sensitivity and pancreatic β-cell function from an oral glucose tolerance test (OGTT) in patients from two cohorts: subjects with PA (n = 21) and essential hypertension control (EHC) subjects (n = 22). Age, sex, BMI, and mean arterial pressure adjusted measures of insulin sensitivity and β-cell function were compared between the groups.

Results

PA individuals were less insulin sensitive compared to EHC subjects (Quantitative insulin sensitivity check index [QUICKI]: 0.340 ± 0.006 vs. 0.374 ± 0.013, p < 0.001; Matsuda index: 4.14 ± 0.49 vs. 7.87 ± 1.42, p < 0.001; SI: 11.45 ± 4.85 vs. 21.23 ± 6.11 dL/kg/min per μU/mL, p = 0.02). The hepatic insulin resistance index (HIRI) was higher in PA subjects (PA: 5.61 ± 1.01 vs. EHC: 4.13 ± 0.61, p = 0.002). The insulinogenic index (IGI), an index of β-cell function was higher in the PA cohort (PA: 1.49 ± 0.27 vs. 1.11 ± 0.21 μU/mL/mg/dL, p = 0.03). However, the oral disposition index (DI) was similar between the groups (PA: 4.77 ± 0.73 vs. EHC: 5.46 ± 0.85, p = 0.42), which likely accounts for the similar glucose tolerance between the two cohorts, despite lower sensitivity.

Conclusions

In summary, insulin sensitivity is significantly lower in PA with an appropriately compensated β-cell function. These results suggest that excess aldosterone and/or other steroids in the context of PA may negatively affect insulin action without adversely impacting β-cell function.

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Funding

This work was supported in part by the Intramural Research Program of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Bethesda, Maryland.

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  1. Clinical Endocrine Section, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA

    Shivraj Grewal, Andin Fosam, Liam Chalk, Arjun Deven, Mari Suzuki, Jenny E. Blau & Ranganath Muniyappa

  2. National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA

    Ricardo Rafael Correa, Andrew Paul Demidowich & Constantine A. Stratakis

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  1. Shivraj Grewal
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Grewal, S., Fosam, A., Chalk, L. et al. Insulin sensitivity and pancreatic β-cell function in patients with primary aldosteronism. Endocrine 72, 96–103 (2021). https://doi.org/10.1007/s12020-020-02576-y

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