Cortisol excess in patients with primary aldosteronism impacts on left ventricular hypertrophy

Context Primary aldosteronism (PA) represents the most frequent form of endocrine hypertension. Hyperaldosteronism and hypercortisolism both induce excessive left ventricular hypertrophy (LVH) compared to matched essential hypertensives. In recent studies frequent co-secretion of cortisol and aldosterone has been reported in PA patients. Objective Our aim was to investigate the impact of cortisol co-secretion on left ventricular hypertrophy in PA patients. We determined 24-h excretion of mineralocorticoids and glucocorticoids by gas chromatography-mass spectrometry and assessed cardiac remodeling using echocardiography initially and one year after initiation of treatment for PA. Patients We included 73 patients from the Munich center of the German Conn's registry; 45 with unilateral aldosterone-producing adenoma and 28 with bilateral adrenal hyperplasia. Results At the time of diagnosis, 85% of PA patients showed left ventricular hypertrophy according to left ventricular mass index (LVMI, median 62.4 g/m2.). LVMI correlated positively with total glucocorticoid excretion (r2=0.076, p=0.018) as well as with tetrahydroaldosterone excretion (r2=0.070, p=0.024). Adrenalectomy led to significantly reduced LVMI in aldosterone-producing adenoma (p