title: Cardiovascular complications of patients with aldosteronism associated with autonomous cortisol secretion.
abstract: BACKGROUND
  Primary aldosteronism (PA) is sometimes associated with the autonomous secretion of cortisol.
  
  
  OBJECTIVE
  Our objective was to investigate the effect of autonomous cortisol secretion on the prevalence of cardiovascular events (CVE) in patients with PA.
  
  
  METHODS
  This was a retrospective cross-sectional study of cases collected from Gunma University Hospital between 2002 and 2010.
  
  
  METHODS
  Seventy-six consecutive patients hospitalized for an evaluation of PA were analyzed.
  
  
  METHODS
  Rates of CVE dependent on autonomous cortisol secretion were examined.
  
  
  RESULTS
  Of the 76 patients with PA, 21 (28%) had a history of CVE, including 14 with stroke, one with myocardial infarction, and six with atrial fibrillation. The multivariate logistic-regression and receiver operating characteristic analyses revealed that PA patients with CVE had significantly higher midnight cortisol levels than those without CVE; the adjusted odds ratio with a cutoff value of 7.4 μg/dl was 7.0 (95% confidence interval, 1.8-30.6; P = 0.006). In addition, results of the 1-mg dexamethasone suppression test with a cutoff value of 3.0 μg/dl differed significantly (odds ratio, 5.0; 95% confidence interval, 1.4-20.7; P = 0.018). Conversely, 67 and 50% of the PA patients with a midnight cortisol level of at least 7.4 μg/dl and 1-mg dexamethasone suppression test of at least 3.0 μg/dl had a history of CVE. Other factors such as age, expected glomerular filtration rate, blood pressure, glucose intolerance, the serum aldosterone concentration, plasma renin activity, and the duration of hypertension had no effect.
  
  
  CONCLUSIONS
  The patients with PA associated with autonomous cortisol secretion had high incidence of CVE, and this association may further increase the risk of CVE in patients with PA.
authors: Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Gunma 371-8511, Japan.
authors: Yasuyo
authors: Y
authors: Nakajima
authors: Masanobu
authors: M
authors: Yamada
authors: Ryo
authors: R
authors: Taguchi
authors: Tetsurou
authors: T
authors: Satoh
authors: Koshi
authors: K
authors: Hashimoto
authors: Atsushi
authors: A
authors: Ozawa
authors: Nobuyuki
authors: N
authors: Shibusawa
authors: Shuichi
authors: S
authors: Okada
authors: Tsuyoshi
authors: T
authors: Monden
authors: Masatomo
authors: M
authors: Mori