Relationship Between Visceral Fat and Plasma Aldosterone Concentration in Patients With Primary Aldosteronism

Yui Shibayama; Norio Wada; Shuhei Baba; Yukie Miyano; Shinji Obara; Ren Iwasaki; Haruka Nakajima; Hidetsugu Sakai; Hiroaki Usubuchi; Satoshi Terae; Akinobu Nakamura; Tatsuya Atsumi


J Endo Soc. 2018;2(11):1236-1245. 

In This Article

Abstract and Introduction


Context: The involvement of visceral fat in aldosterone secretion has not been reported in patients with primary aldosteronism (PA). Patients with PA are complicated by metabolic syndrome more frequently than those without PA. An excess of visceral fat has been hypothesized to cause an elevation of aldosterone secretion in patients with PA.

Objectives: To clarify the role of visceral fat in the pathophysiology of PA, we investigated the correlation between plasma aldosterone concentration (PAC) and visceral fat parameters in patients with PA.

Design: This retrospective observational study comprised 131 patients diagnosed with PA between April 2007 and April 2017 at Sapporo City General Hospital. We divided participants into two PA subtypes, aldosterone-producing adenoma (APA; n = 47) and idiopathic hyperaldosteronism (IHA, n = 84), utilizing adrenal venous sampling. We analyzed the correlations of PAC with visceral fat percentage (VF%), visceral fat area (VFA), and subcutaneous fat area, by evaluating computed tomography studies in each subtype group.

Results: Patients with IHA showed a positive correlation of PAC with VF% (r = 0.377, P < 0.001) and VFA (r = 0.443, P < 0.001). The correlation was not evident in patients with APA.

Conclusions: This study revealed a relationship between visceral adipose tissue and aldosterone production only in patients with IHA.


Since the 1960s, a number of studies have shown the association between obesity and essential hypertension.[1] Abdominal fat distribution has been well recognized as increasing the risk of health problems, namely, metabolic syndrome.[2] In particular, visceral adipose tissue (VAT) is independently correlated with hypertension, insulin resistance, dyslipidemia, and, ultimately, coronary heart disease.[3]

Primary aldosteronism (PA) is one of the most common forms of secondary hypertension, with prevalence of up to 10% of all patients with hypertension.[4,5] Metabolic syndrome is more frequent in patients with PA than in patients with essential hypertension, with equivalent body mass index (BMI) and blood pressure.[6] Monticone et al.[7] reported that compared with patients with essential hypertension, patients with PA had an increased risk of stroke, coronary artery disease, atrial fibrillation, diabetes, and metabolic syndrome. Among patients with PA, BMI is significantly higher in patients with nonlateralized PA than in those with lateralized PA.[8]

We established our database of patients with PA, with quantitative determination of VAT using computed tomography (CT). We hypothesized that VAT is involved in the elevation of aldosterone secretion in PA, based on a previous report suggesting a positive correlation between plasma aldosterone concentration (PAC) and visceral fat area (VFA) in patients without PA.[9] Therefore, we explored the correlation between precise VAT volume and PAC in patients with PA. Because the pathophysiology of hypertension in PA is fundamentally different between aldosterone-producing adenoma (APA) and idiopathic hyperaldosteronism (IHA), we further investigated the correlation of VAT volume to PAC, either in APA or in IHA, which were discriminated using adrenal venous sampling (AVS).