Prevalence, risk factors and evolution of diabetes mellitus after treatment in primary aldosteronism. Results from the SPAIN-ALDO registry.

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.

Vitamina D y trasplante hepático, ¿Sólo efectos óseos? / Is the role ot Vitamin D in liver transplantation limited to bone health?

La osteoporosis postrasplante causa una importante morbilidad en la creciente población de supervivientes del trasplante hepático. Los fármacos inmunosupresores habitualmente empleados son uno de los principales responsables de la osteoporosis postrasplante. La vitamina D y sus análogos sintéticos podrían ser útiles en el período postrasplante, ya que a sus efectos protectores a nivel óseo se añade su papel inmunomodulador, en particular de la inmunidad mediada por células T, lo que podría permitir no sólo disminuir la dosis de inmunosupresores, sino también colaborar en la prevención de la aparición de rechazo crónico

Liver transplantation has become a fairly common and successful procedure, and post-transplantation osteoporosis is now a usual complication in these patients. Immuno-suppressive therapy has been involved in this setting. Vitamin D and their related analogs may have a role in the post-transplantation therapy, adding the role of immuno-modulator (mainly in T cells) to their already protective one in bone metabolism. This might not only allow for the possibility of reducing immuno-suppressive doses, but also of reducing instances of transplant rejections