Influence of Renin-Angiotensin-Aldosteron system on the glucose metabolism in patients with adrenal incidentalomas

CILJ ISTRAŽIVANJA: U bolesnika s incidentalomom utvrditi utjecaj renin-angiotensin-aldosteron sustava na metabolizam glukoze NACRT ISTRAŽIVANJA: Presječno istraživanje iz povijesti bolesti. ISPITANICI I POSTUPCI: U istraživanje su uključeni svi pacijenti koji su u razdoblju od 2016. do 2018. godine liječeni na Klinici za unutarnje bolesti KBC-a Osijek pod dijagnozom incidentaloma nadbubrežne žlijezde. Bolesnici su podijeljeni u dvije skupine: one s patološkim omjerom i one s urednim (kontrolna skupina) ARR. Uključni kriteriji bili su: bolesnici s incidentalomom nadbubrežne žlijezde, verificirani CT-om, nesekretorne prirode. Isključni kriteriji bili su sekretorna priroda incidentaloma, te prethodni dijabetes u anamnezi. Razina značajnosti bila je postavljena na Alpha=0,05. Za statističku analizu korišten je statistički program MedCalc Statistical Software version 18.9 (MedCalc Software bvba, Ostend, Belgium; http://www.medcalc.org; 2018) REZULTATI: Istraživanje je provedeno na 94 pacijenta, od kojih je 39 (42 %) muškaraca i 55 (58 %) žena. Patološki ARR imalo je 54 (57,4 %) pacijenata, dok je 40 (42,6 %) imalo uredan. Nije bilo razlika u biokemijskim pokazateljima i razini GUP-a i HbA1c ovisno o tome ima li bolesnik patološki ili uredan ARR, niti je utvrđena korelacija između razina GUP-a/HbA1c i razina aldosterona. Jedini biokemijski pokazatelj koji je pokazao značajnu korelaciju bio je kalij u obrnuto proporcionalnoj korelaciji s razinama aldosterona i RAP-a. Karakteristike tumora nisu pokazale značajne osobitosti, podjednaka je incidencija incidentaloma u oba spola i podjednaka je pojavnost u obje nadbubrežne žlijezde te se jednako često javljaju unilateralni i bilateralni tumori. S obzirom da razine aldosterona i RAP-a obrnuto proporcionalno koreliraju s razinama kalija, aldosteron endogeno izlučen u bolesnika s incidentalomom uzrokuje neki spektar hipokalijemije. ZAKLJUČAK: Ovaj rad nije dokazao povezanost između ARR i razina GUP-a koja bi dokazala da RAAS ima utjecaj na metabolizam glukoze, ali je ukazao na patološki lipidogram, pretilost i hipertenziju velike većine pacijenata s incidentalomom. Ovom studijom zaključeno je i da više od pola pacijenata ima patološki ARR koja korelira s razinama kalija te se kod tih pacijenata bilježe niže vrijednosti kalija.OBJECTIVES: Determining the impact of the renin-angiotensin-aldosterone system on glucose metabolism on patients with an adrenal gland incidentaloma. STUDY DESIGN: Cross-sectional study. PATIENTS AND METHODS: This study included all patients who were treated at the Clinical Hospital Center Osijek, Clinic for Internal Medicine, during the period from 2016 to 2018 under the diagnosis of adrenal incidentaloma. The patients were divided in two groups: one with high level of ARR and the other with normal ARR. The inclusion criteria were: patients with adrenal incidentaloma verified by CT and the non-secretory nature of the tumour. Exclusion criteria were the secretory nature of the incidentaloma and prior diabetes in the patients’ history. The level of significance was set at alpha = 0.05. For statistical analysis, the MedCalc Statistical Software version 18.9 (MedCalc Software bvba, Ostend, Belgium; http://www.medcalc.org; 2018) was used. RESULTS: The research included 94 patients, 39 male (42 %) and 55 female (58 %). 54 patients (57,4 %) had high level of ARR, while 40 (42,6 %) had normal level ARR. There was no significant difference between biochemical indicators and the level of plasma glucose or HbA1c depending on whether the patient has a high-level or normal ARR, nor was the correlation between the glucose levels or HbA1c with aldosterone levels established. The only biochemical indicator that showed significant correlation was potassium in inversely proportional correlation with aldosterone and RAP levels. There were no significant differences in tumour characteristics, the incidence of adrenal incidentalomas in both sexes was equal, as well as the occurrence in the left or right adrenal gland, while unilateral and bilateral tumours are equally frequent. CONCLUSION: This study did not show the correlation between ARR and plasma glucose levels that would prove that RAAS has an impact on glucose metabolism. However, it did show that patients with adrenal incidentalomas have higher body mass index, hypertension more often, and high lipid levels. This study demonstrated that more than half of the patients with adrenal incidentalomas have high-level ARR, which was in reverse correlation with potassium levels