6543 Increased Prevalence of Uterine Myoma in Patients with Idiopathic Hyperaldosteronism
Authors: Yamashita K , Morimoto S , Kimura S , Seki Y , Bokuda K , Watanabe D , Ichihara A 
Published: October 2024

Disclosure: K. Yamashita: None. S. Morimoto: None. S. Kimura: None. Y. Seki: None. K. Bokuda: None. D. Watanabe: None. A. Ichihara: None.

Objectives: Primary aldosteronism (PA) is a common cause of endocrine hypertension, contributing to organ damage in the cerebral, cardiac, and renal vascular systems due to autonomous aldosterone overproduction. Uterine myoma, though benign, gives rise to significant gynecological issues including excessive menstrual bleeding, dysmenorrhea, infertility, and preterm labor. Hypertension is a risk factor for uterine myoma, and the renin-angiotensin-aldosterone system (RAAS) is implicated in the proliferation of myometrial cells. Nevertheless, the association between PA and the development of uterine myoma remains elusive. Therefore, this study aimed to explore the incidence of uterine myoma in patients with PA. Methods: We conducted a retrospective study involving female patients diagnosed with idiopathic hyperaldosteronism (IHA) through adrenal vein sampling from January 2010 to January 2019. Age-matched female patients diagnosed with essential hypertension (EH) during the same period served as controls. Patients taking medications affecting the RAAS were excluded from the study. The relationships between the incidence of uterine myoma and patients' background factors were examined in the IHA and EH groups. Additionally, immunohistochemical staining for the mineralocorticoid receptor (MR) was performed on excised specimens from patients who underwent surgery for uterine myoma. Results: There were no significant differences between the two groups in terms of age, alcohol consumption, smoking rate, blood pressure, heart rate, body mass index (BMI), estimated glomerular filtration rate (eGFR), potassium (K), hemoglobin A1c (HbA1c), and plasma aldosterone concentration (PAC). Plasma renin activity (PRA) was significantly lower, and the aldosterone-to-renin ratio (ARR) was significantly higher in the IHA group (P &lt; 0.0001). The incidence of uterine myoma was significantly higher in the IHA group (20%) than in the EH group (10%) (P = 0.0145). Among patients' background factors, only the diagnosis of IHA showed a significant association with the incidence of uterine myoma (ρ = 0.1379, P = 0.0144). The association with the incidence of uterine myoma was significantly higher in the IHA group compared to the EH group (odds ratio = 2.2705, 95% CI = 1.16-4.44, P = 0.0164). In the IHA group, a history of alcohol consumption, higher BMI, and lower PRA were independently associated with the incidence of uterine myoma. Immunohistochemical examination exhibited MR expression in the uterine myoma tissues of both IHA and EH patients, suggesting potential involvement of aldosterone excess in the development of uterine myoma. Conclusions: In patients with IHA, the incidence of uterine myoma was higher compared to patients with EH. Risk factors identified for the higher incidence of uterine myoma in IHA patients included a history of alcohol consumption, elevated BMI, and lower PRA.

Presentation: 6/1/2024