Journal Article

Influence of body mass index on disease severity and treatment outcomes in primary aldosteronism

Perdomo, Carolina M, Michalopoulou, Theodora, Ruiz-Sanchez, Jorge Gabriel, Gonzalvo Diaz, Cesar, Monticone, Silvia, Calatayud, María, Goi, Jessica, Rebollo Román, Ángel, Barahona San Millan, Rebeca, García Centero, Rogelio, Burrello, Jacopo, Schneider, Holger, Muñoz Rivas, Nuria, Paja Fano, Miguel, Parra Ramírez, Paola, Tenes Rodrigo, Susana, Jaén Aguila, Fernando, García Cano, Ana María, Recio, José María, Lamas, Cristina, Adel Gamil, Aster, González-Boillos, Marga, Torres, Ana, Mulatero, Paolo, Johann Petersenn, Erik, Rizo Gellida, Alicia, Serrano, Joaquín, Araujo-Castro, Marta, Díaz Guardiola, Patricia, Gutiérrez-Medina, Sonsoles, Recasens, Mònica, Robles Lázaro, Cristina, Moya Mateo, Eva María, Zopp, Stephanie, Gómez-Hoyos, Emilia, Picón César, María José, Capuzzo, Virginia, Mena Ribas, Elena, Bersano, Elena, Sanmartín Sánchez, Alicia, Martín Rojas-Marcos, Patricia, Reincke, Martin

2026

Overview

Abstract Purpose To assess the impact of body mass index (BMI) on disease severity, cardiac remodeling, and clinical and biochemical outcomes after surgical and medical treatment in patients with primary aldosteronism (PA). Methods This international retrospective study included patients diagnosed with PA in Germany, Italy, and Spain. Patients with available BMI, serum potassium, blood pressure, and basal plasma aldosterone concentration at diagnosis were included. PA severity was classified using the Primary Aldosteronism Severity Classification. Results A total of 1752 patients were analyzed at baseline; 604 (34.5%) had obesity (BMI ≥30 kg/m2). Patients with obesity were older, more frequently male, and had a higher prevalence of cardiometabolic comorbidities, including type 2 diabetes, cardiovascular disease, left ventricular hypertrophy, and obstructive sleep apnea. PA severity according to the Primary Aldosteronism Severity Classification did not differ significantly between patients with and without obesity; however, the prevalence of severe PA increased progressively across BMI categories (MH test for linear trend: χ2(1) = 3.70, P = .054). Following adrenalectomy, the probability of complete hypertension resolution decreased with increasing BMI, whereas biochemical cure rates were similar. Among patients treated with mineralocorticoid receptor antagonists, obesity was associated with a lower likelihood of complete clinical response, without significant differences in biochemical response. Conclusion In patients with PA, obesity is associated with a higher burden of cardiometabolic comorbidities and increased prevalence of left ventricular hypertrophy at baseline, as well as with less favorable clinical outcome after both surgical and medical treatment.

• Publisher: Oxford University Press,The Endocrine Society
• Subject: Body mass index / Clinical / Obesity