The adverse effect of excess aldosterone on insulin metabolic signaling (Figure 1) has generated increasing interest in the role of hyperaldosteronism in the pathogenesis of insulin resistance and resistant hypertension. This association was initially described more than 4 decades ago in individuals with primary hyperaldosteronism and impaired glucose tolerance (34). Increased plasma aldosterone levels are associated with insulin resistance independent of other components of the metabolic syndrome (35-37). In patients with primary hyperaldosteronism, resection of aldosterone-producing tumors and pharmacologic treatment both decrease blood insulin and glucose levels, which indicates an improvement in insulin sensitivity (37,38).
Via the Yahoo PA group, this really great article just came my way, addressing the relationship of aldosterone to insulin resistance. I’ve been saying this all along, but this is the first time I’ve found Actual! Scientific! Evidence!! to back it up.
I’m happy to be able to report that now, nearly a year and a half after my adrenalectomy, I continue to no longer show ANY signs of insulin resistance. When my illness first became apparent in my early 30s, I thought the sudden weight gain concentrated in my midsection was due to approaching middle-age. When this was followed by abnormal labs showing IR and borderline high fasting glucose, I thought I was not only doomed to a typical apple-shaped middle-aged body, but to the diabetes that runs in my maternal family. This all seemed terribly incongruous to the lifestyle I was living – unlike my maternal relatives, who smoked like chimneys, drank like sailors, and lived in the suburbs planted on their butts in front of the TV or in their cars, I lived in the city and walked everywhere, was (then) a vegetarian with a textbook-perfect diet, practiced yoga, went hiking, rarely drank, and had smoked a cigarette exactly once in my life. It didn’t seem fair. Hell, it wasn’t fair.
But. The tumor is gone, and so is the weight gain, the abdominal obesity, the worry that I will have to face diabetic foot in my lifetime (warning, extremely graphic Google image search). And I say this all the time, but I have to say it again – I am so, so incredibly grateful to everyone – the doctors, the hospital staff, the friends who saw me through this journey – that I have this second chance.
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I get stupid thankful about this, just about every day of my life. After seeing a most amazing gig last night with a dear friend, I was already bordering on the stupid-emotional side. He asked me, as he does from time to time, how I was doing health-wise. I’m not a crier, but I came thisclose to bursting out in tears. That I am doing okay – that I am doing damn fine, even – that I have friends who remember what I’ve gone through and who care enough to check in about that, is just something that overwhelms me almost every single day. Sometimes that fact that I am here, and well, is the thing that doesn’t seem fair nowadays, since every day that I check into the Yahoo group it seems that there is yet another person who is NOT doing well at all. I realize life can be, in general, a matter of luck – I’m lucky to live five minutes from a research hospital, I’m lucky to be a trained researcher myself who can read articles like the one linked above, I’m lucky that my disease was caught before it did any real damage. And the fact that not everyone afflicted with this condition has equal access to the resources I do absolutely pains me.