The impact of Connshing's syndrome - mild cortisol excess in primary aldosteronism drives diabetes risk

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With great interest, we have read the recent study by Wu et al.[1]. By taking advantage of the Taiwan National Health Insurance database, the authors provide evidence that in patients with primary aldosteronism, treatment by adrenalectomy (ADX) significantly reduced the risk of new-onset diabetes mellitus (NODM) to the level observed in patients with essential hypertension. Significantly, patients receiving medical therapy of primary aldosteronism with mineralocorticoid receptor antagonist (MRA) had a significantly higher risk of diabetes than patients with essential hypertension. The authors suggest some potential explanations for these disparate results: Although ADX would normalize aldosterone hypersecretion levels shortly after surgery, MRA therapy could augment circulating aldosterone serum levels, which might be associated with deleterious nongenomic effects of aldosterone. Further explanations might include low long-term adherence to MRA therapy and a more pronounced effect on blood pressure control by ADX.

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