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. 2025 Feb 10;13(2):52.
doi: 10.3390/diseases13020052.

Occurrence of Metabolic Disorders in Bilateral Primary Aldosteronism Compared to Unilateral Primary Aldosteronism

Chiara Grasselli  1 , Maicol Baldini  1 , Lucia Salvi  1 , Grazia Vestita  1 , Maurizio Zizzo  2 , Davide Felaco  3 , Maria Carolina Balli  3 , Giulia Besutti  3   4 , Aurelio Negro  1 , Angelo Ghirarduzzi  1
Affiliations

Occurrence of Metabolic Disorders in Bilateral Primary Aldosteronism Compared to Unilateral Primary Aldosteronism

Chiara Grasselli et al. Diseases. .

Abstract

Background: Metabolic syndrome (MetS) is a common comorbidity associated with hypertension that occurs more often in primary aldosteronism (PA). Our work aims to investigate the prevalence of MetS and its determinants in unilateral PA and bilateral PA, as confirmed by adrenal venous sampling (AVS).

Methods: This was a retrospective, cross-sectional study. We investigated metabolic indicators in 160 cases of PA, categorized by AVS-82 with unilateral PA and 78 with bilateral PA. A control group of 80 non-PA patients with essential hypertension, matched for age and sex, was also included.

Results: Unilateral PA had a higher aldosterone-renin ratio and lower serum potassium levels than bilateral PA. Nevertheless, bilateral PA exhibited a higher prevalence of MetS (41% vs. 30.5%; p = 0.001), obesity, BMI, LDL hypercholesterolemia, and hypertriglyceridemia than unilateral PA.

Conclusions: Bilateral PA presents a greater incidence of MetS than unilateral PA, in spite of the latter showing a higher aldosterone-renin ratio and lower serum potassium levels. The results suggest that the mechanisms underlying MetS may differ between unilateral and bilateral PA.

Keywords: metabolic syndrome; obesity; primary aldosteronism.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Relationship between mineralocorticoid (MC) system activity and metabolic syndrome (MetS). Increased MC activity can lead to MetS and adiposity, which may, in turn, contribute to the maintenance of MC activity, resulting in the further progression of adiposity and MetS.
Figure 2
Figure 2
(a) The PA and non-PA groups did not show a significant difference in prevalence. (b) The incidence of MetS was higher in individuals with unilateral PA compared to those with bilateral PA and essential hypertension. (c) Greater prevalence of obesity, LDL hypercholesterolemia, and hypertriglyceridemia in bilateral PA compared to unilateral PA. Abbreviations: PA—patients with primary aldosteronism; Non-PA—patients without primary aldosteronism; MetS—metabolic syndrome; APA—aldosterone-producing adenoma; BAH—bilateral adrenal hyperplasia.
Figure 2
Figure 2
(a) The PA and non-PA groups did not show a significant difference in prevalence. (b) The incidence of MetS was higher in individuals with unilateral PA compared to those with bilateral PA and essential hypertension. (c) Greater prevalence of obesity, LDL hypercholesterolemia, and hypertriglyceridemia in bilateral PA compared to unilateral PA. Abbreviations: PA—patients with primary aldosteronism; Non-PA—patients without primary aldosteronism; MetS—metabolic syndrome; APA—aldosterone-producing adenoma; BAH—bilateral adrenal hyperplasia.
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