Adrenalectomy may improve Diabetes symptoms in nearly half of primary aldosteronism patients with DM

China: Researchers from China found that Adrenalectomy was successful in remitting and improving Diabetes in nearly half of primary aldosteronism (PA) patients with Diabetes. Longer duration of hypertension, a higher concentration of urinary magnesium and higher 24 h urinary potassium could hinder the remission and improvement, but examination of urinary electrolytes can predict the outcomes of Diabetes in PA patients. The study results were published in the journal BMC Endocrine Disorders. 

Primary aldosteronism (PA) is characterized by hypertension, excessive aldosterone excretion, and low serum potassium. Adrenalectomy and mineralocorticoid receptor antagonists are the recommended therapies for PA patients. Recent literature showed that adrenalectomy would improve insulin secretion in PA patients despite some studies stating that blood glucose levels did not alter. Hence Chinese researchers from the West China Hospital, Sichuan University conducted a study to evaluate the outcome of diabetes after adrenalectomy and determine the factors associated with that in PA patients. 

PA patients with DM (PA + DM patients) who received adrenalectomy were recruited into the study. Based on the diabetes outcomes after treatment, patients were classified into 3 groups, including “remission”, “improved” and “unchanged” groups. The preoperative factors affecting the outcome of DM after adrenalectomy were uncovered by univariate and multivariate logistic regression analysis. 

Key findings of the study: 

• A total of 54 PA + DM patients received adrenalectomy.
• Post adrenalectomy, 16.7%, 33.3%, and 50.0% of patients were classified into the “remission”, “improved” and “unchanged” groups, respectively.
• The factors negatively associated with remission or improvement from DM after adrenalectomy were longer duration of hypertension (P = 0.029), a higher concentration of urinary magnesium (P = 0.031), and higher 24 h urinary potassium (P = 0.049).  

Thus, diabetes could be improved with adrenalectomy in nearly half of the patients with Diabetes. 

Further reading: Liu, Y., Lin, L., Yuan, C. et al. Recovery from diabetes mellitus in primary aldosteronism patients after adrenalectomy. BMC Endocr Disord 22, 331 (2022). https://doi.org/10.1186/s12902-022-01254-6