RESUMO
PURPOSE: To evaluate the prevalence, risk factors and evolution of diabetes mellitus (DM) after targeted treatment in patients with primary aldosteronism (PA). METHODS: A retrospective multicenter study of PA patients in follow-up at 27 Spanish tertiary hospitals (SPAIN-ALDO Register). RESULTS: Overall, 646 patients with PA were included. At diagnosis, 21.2% (n = 137) had DM and 67% of them had HbA1c levels < 7%. In multivariate analysis, family history of DM (OR 4.00 [1.68-9.53]), the coexistence of dyslipidemia (OR 3.57 [1.51-8.43]) and advanced age (OR 1.04 per year of increase [1.00-1.09]) were identified as independent predictive factors of DM. Diabetic patients were on beta blockers (46.7% (n = 64) vs. 27.5% (n = 140), P < 0.001) and diuretics (51.1% (n = 70) vs. 33.2% (n = 169), p < 0.001) more frequently than non-diabetics. After a median follow-up of 22 months [IQR 7.5-63.0], 6.9% of patients developed DM, with no difference between those undergoing adrenalectomy and those treated medically (HR 1.07 [0.49-2.36], p = 0.866). There was also no significant difference in the evolution of glycemic control between DM patients who underwent surgery and those medically treated (p > 0.05). CONCLUSION: DM affects about one quarter of patients with PA and the risk factors for its development are common to those of the general population. Medical and surgical treatment provides similar benefit in glycemic control in patients with PA and DM.
Assuntos
Diabetes Mellitus , Hiperaldosteronismo , Humanos , Prevalência , Espanha/epidemiologia , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/etiologia , Fatores de Risco , Hiperaldosteronismo/complicações , Hiperaldosteronismo/epidemiologia , Hiperaldosteronismo/terapia , Sistema de RegistrosRESUMO
A case is presented of Nelson's Syndrome concomitant with Cushing's Syndrome in a female patient who underwent five years earlier bilateral adrenalectomy due to Cushing's Disease. Together with hyperpigmentation, very elevated ACTH, and intrasellar mass in CT scan, plasma cortisol levels without rythm and not suppressible were observed as well as increased cortisol in urine. The macroadenoma was resected though the sphenoid and later hypophysis radiotherapy was given, with a clinical remission and biochemical improvement of the syndrome. At the present time, slightly elevated ACTH levels persist, with panhypopituitarism and empty sella turcica. The clinical picture is described and a literature search is carried out.