MON-698 - Stimulated Aldosterone Levels in Obesity

Background: Prior studies report elevated basal aldosterone in people with obesity, while ACTH-stimulated levels appear similar to lean controls.

Objective: To compare basal and ACTH-stimulated aldosterone responses to a 1-µg intravenous ACTH bolus in healthy adults with obesity versus lean controls.

Methods: Serum aldosterone and cortisol were measured at baseline and following 1-µg ACTH in 24 adults with obesity (mean BMI 36 kg/m²) and 18 lean controls (mean BMI 23 kg/m²). Age and sex distribution were comparable. All participants were normotensive, though blood pressure was higher in the obesity group (122±13.5/76.3±9.2 vs 113.6±7.1 mmHg).

Results: Baseline log10 -transformed aldosterone was positively correlated with waist/height ratio (r=0.38, p=0.058) but not BMI. log10 transformed aldosterone at 20 minutes was 30% higher in subjects with obesity as compared to controls (p=0.038). Area over the curve (AUC) of log10 transformed aldosterone was also nonsignificantly higher in the group with obesity (p=0.065). AUC of aldosterone to cortisol ratio was significantly higher in subjects with obesity as compared to controls (p=0.046).

Conclusion: Individuals with obesity demonstrate an enhanced aldosterone response to low-dose ACTH stimulation. The significantly higher aldosterone-to-cortisol ratio suggests a specific shift toward increased mineralocorticoid output in obesity, potentially serving as an early driver for blood pressure elevation and increased cardiovascular risk.

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