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Eva O Melin Department of Clinical Sciences, Endocrinology and Diabetes, Lund University, Lund, Sweden
Department of Research and Development, Växjö, Sweden
Primary Care, Växjö, Sweden

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Jonatan Dereke Department of Clinical Sciences Lund, Diabetes Research Laboratory, Lund University, Lund, Sweden

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Maria Thunander Department of Clinical Sciences, Endocrinology and Diabetes, Lund University, Lund, Sweden
Department of Research and Development, Växjö, Sweden
Department of Internal Medicine, Endocrinology and Diabetes, Central Hospital, Växjö, Sweden

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Magnus Hillman Department of Clinical Sciences Lund, Diabetes Research Laboratory, Lund University, Lund, Sweden

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of 433 eligible patients ( Fig. 1 ). Thus, 287 patients were included in this study. A questionnaire was used to assess self-reported depression. Blood samples, anthropometrics and blood pressure (BP) were collected. Data were collected from

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N Bergmann Endocrine Unit, The National Research Centre for the Working Environment, Faculty of Health Sciences, Department of Medicine O, Herlev University Hospital, DK-2730 Herlev, Denmark

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F Gyntelberg Endocrine Unit, The National Research Centre for the Working Environment, Faculty of Health Sciences, Department of Medicine O, Herlev University Hospital, DK-2730 Herlev, Denmark

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J Faber Endocrine Unit, The National Research Centre for the Working Environment, Faculty of Health Sciences, Department of Medicine O, Herlev University Hospital, DK-2730 Herlev, Denmark
Endocrine Unit, The National Research Centre for the Working Environment, Faculty of Health Sciences, Department of Medicine O, Herlev University Hospital, DK-2730 Herlev, Denmark

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) . There is no general consensus on how to measure chronic stress. Some have used physiological changes from the activation of the HPA- and SAM-axes as measures of stress: i.e. cortisol, noradrenalin, blood pressure (BP), or resting pulse (5) . However

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Anastasia P Athanasoulia-Kaspar Clinical Neuroendocrinology, Max Planck Institute of Psychiatry, Munich, Germany

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Matthias K Auer Clinical Neuroendocrinology, Max Planck Institute of Psychiatry, Munich, Germany
Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, Germany

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Günter K Stalla Clinical Neuroendocrinology, Max Planck Institute of Psychiatry, Munich, Germany

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Mira Jakovcevski Department of Stress Neurobiology and Neurogenetics, Max Planck Institute of Psychiatry, Munich, Germany

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telomeres seem to be associated with age-related disease ( 7 ) as well as inflammatory states, cardiovascular disease, diabetes mellitus type 2 (DM2), poor lipid profile and high blood pressure ( 8 , 9 , 10 ). Furthermore, a variety of factors such as

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Hugo R Ramos Department of Internal Medicine, Section of Metabolic Vascular Medicine, Division of Diabetes and Nutritional Sciences, Cardiovascular Endocrinology Laboratory, Faculty of Medicine, Hospital de Urgencias, National University of Córdoba, X5000 Córdoba, Argentina

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Andreas L Birkenfeld Department of Internal Medicine, Section of Metabolic Vascular Medicine, Division of Diabetes and Nutritional Sciences, Cardiovascular Endocrinology Laboratory, Faculty of Medicine, Hospital de Urgencias, National University of Córdoba, X5000 Córdoba, Argentina
Department of Internal Medicine, Section of Metabolic Vascular Medicine, Division of Diabetes and Nutritional Sciences, Cardiovascular Endocrinology Laboratory, Faculty of Medicine, Hospital de Urgencias, National University of Córdoba, X5000 Córdoba, Argentina

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Adolfo J de Bold Department of Internal Medicine, Section of Metabolic Vascular Medicine, Division of Diabetes and Nutritional Sciences, Cardiovascular Endocrinology Laboratory, Faculty of Medicine, Hospital de Urgencias, National University of Córdoba, X5000 Córdoba, Argentina

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: hypertriglyceridemia (1.7 mmol/l), low HDL cholesterol (<1.03 mmol/l in men and <1.29 mmol/l in women), hyperglycemia (>11.1 mmol/l or a diagnosis of diabetes), hypertension (≥130/85 mmHg) or medication for high blood pressure (34, 35) . In a 12-year follow-up of 61

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Riccardo Pofi Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism and NIHR Oxford Biomedical Research Centre, Churchill Hospital, University of Oxford, Oxford, UK

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Ilaria Bonaventura Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena, Rome, Italy

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Joanne Duffy Department of Clinical Chemistry and Immunology, Heartlands Hospital, Birmingham, UK

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Zoe Maunsell Department of Clinical Biochemistry, Oxford University Hospitals NHS Foundation Trust, Oxford, UK

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Brian Shine Department of Clinical Biochemistry, Oxford University Hospitals NHS Foundation Trust, Oxford, UK

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Andrea M Isidori Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena, Rome, Italy

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Jeremy W Tomlinson Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism and NIHR Oxford Biomedical Research Centre, Churchill Hospital, University of Oxford, Oxford, UK

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assessment (salt craving, blood pressure or oedema) and measuring blood electrolytes and renin. General well-being, maintaining electrolytes in the normal range alongside a normal blood pressure without evidence of postural hypotension and achieving renin

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Jia Liu Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Chaoyang District, Beijing, China

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Lin Zhang Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Chaoyang District, Beijing, China

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Jing Fu Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Chaoyang District, Beijing, China

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Qiu Wang Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Chaoyang District, Beijing, China

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Guang Wang Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Chaoyang District, Beijing, China

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pregnant, lactating, or took any medications which influence PRL, glucose, lipid, or blood pressure were excluded. In order to investigate the association between PRL and metabolic alterations in the early stages of metabolic abnormalities, participants

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Satoshi Higuchi Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Miyagi, Japan

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Hideki Ota Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Miyagi, Japan
Department of Advanced MRI Collaboration Research, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan

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Yuta Tezuka Division of Nephrology, Endocrinology and Vascular Medicine, Department of Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
Department of Radiology, The University of British Columbia, Vancouver, Canada

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Kazumasa Seiji Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Miyagi, Japan

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Hidenobu Takagi Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Miyagi, Japan
Department of Radiology, The University of British Columbia, Vancouver, Canada

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Jongmin Lee Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Korea

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Yi-Wei Lee Department of Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan

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Kei Omata Division of Nephrology, Endocrinology and Vascular Medicine, Department of Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
Department of Radiology, The University of British Columbia, Vancouver, Canada

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Yoshikiyo Ono Division of Nephrology, Endocrinology and Vascular Medicine, Department of Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
Department of Radiology, The University of British Columbia, Vancouver, Canada

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Ryo Morimoto Division of Nephrology, Endocrinology and Vascular Medicine, Department of Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan

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Masataka Kudo Division of Nephrology, Endocrinology and Vascular Medicine, Department of Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan

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Fumitoshi Satoh Division of Nephrology, Endocrinology and Vascular Medicine, Department of Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan

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Kei Takase Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Miyagi, Japan

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hypertension due to excessive and autonomous aldosterone production. Independent of its effect on blood pressure, such excess in aldosterone has been associated with cardiovascular damage ( 3 ), including myocardial inflammation ( 4 ), excessive collagen

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Signe Frøssing Department of Internal Medicine, Center of Endocrinology and Metabolism, Herlev Gentofte Hospital, Copenhagen, Denmark
Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark

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Malin Nylander Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
Department of Obstetrics & Gynecology, Herlev Gentofte Hospital, Copenhagen, Denmark

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Caroline Kistorp Department of Internal Medicine, Center of Endocrinology and Metabolism, Herlev Gentofte Hospital, Copenhagen, Denmark
Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark

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Sven O Skouby Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
Department of Obstetrics & Gynecology, Herlev Gentofte Hospital, Copenhagen, Denmark

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Jens Faber Department of Internal Medicine, Center of Endocrinology and Metabolism, Herlev Gentofte Hospital, Copenhagen, Denmark
Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark

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crest. Consultation blood pressure was measured three consecutive times after ten minutes of rest in the sitting position. Blood samples were collected in the morning after ten hours overnight fast. A 75 g-oral glucose tolerance test was performed; blood

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Paola Parra Ramírez Endocrinology & Nutrition Department, La Paz University Hospital, Madrid, Spain

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Patricia Martín Rojas-Marcos Endocrinology & Nutrition Department, La Paz University Hospital, Madrid, Spain

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Miguel Paja Fano Endocrinology & Nutrition Department, Hospital Universitario de Basurto, Bilbao, Spain
Medicine Department, Basque Country University, Bilbao, Spain

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Marga González Boillos Endocrinology & Nutrition Department, Hospital Universitario de Castellón, Castellón, Spain

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Eider Pascual-Corrales Endocrinology & Nutrition Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Madrid, Spain

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Ana García-Cano Biochemistry Department, Hospital Universitario Ramón y Cajal, Madrid, Spain

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Jorge Gabriel Ruiz-Sanchez Endocrinology & Nutrition Department, Hospital Fundación Jiménez Díaz, Madrid, Spain

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Almudena Vicente Endocrinology & Nutrition Department, Complejo Universitario de Toledo, Toledo, Spain

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Emilia Gómez-Hoyos Endocrinology & Nutrition Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain

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Rui Ferreira Endocrinology & Nutrition Department, Hospital Universitario de La Princesa, Madrid, Spain

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Iñigo García Sanz General & Digestive Surgery Department, Hospital Universitario de La Princesa, Madrid, Spain

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Mònica Recasens Endocrinology & Nutrition Department, Hospital Josep Trueta, Servei d’Endocrinologia, Girona, Spain

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Begoña Pla Peris Endocrinology & Nutrition Department, Hospital Universitario de Castellón, Castellón, Spain

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Rebeca Barahona San Millan Endocrinology & Nutrition Department, Hospital Josep Trueta, Servei d’Endocrinologia, Girona, Spain

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María José Picón César Endocrinology & Nutrition Department, Complejo Hospitalario Málaga (Hospital Virgen de la Victoria), IBIMA Malaga, Malaga, Spain
CIBEROBN, Madrid, Spain

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Patricia Díaz Guardiola Endocrinology & Nutrition Department, Hospital Universitario Infanta Sofía, Madrid, Spain

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Juan Jesús García González Endocrinology & Nutrition Department, Hospital Universitario Virgen de la Macarena, Sevilla, Spain

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Carolina Perdomo Endocrinology & Nutrition Department, Clínica Universidad de Navarra, Pamplona, Spain

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Laura Manjón Endocrinology & Nutrition Department, Hospital Universitario Central de Asturias, Oviedo, Spain
Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain

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Rogelio García-Centeno Endocrinology & Nutrition Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain

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Juan Carlos Percovich Endocrinology & Nutrition Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain

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Ángel Rebollo Román Endocrinology & Nutrition Department, Hospital Reina Sofía, Córdoba, Spain

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Paola Gracia Gimeno Endocrinology & Nutrition Department, Hospital Royo Villanova, Zaragoza, Spain

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Cristina Robles Lázaro Endocrinology & Nutrition Department, Hospital Universitario de Salamanca, Salamanca, Spain

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Manuel Morales Biochemistry and Molecular Genetics Department-CDB, Hospital Clinic, IDIBAPS, CIBERehd, Barcelona, Spain

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Felicia Hanzu Endocrinology & Nutrition Department, Hospital Clinic, Barcelona, Spain

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Marta Araujo-Castro Endocrinology & Nutrition Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Madrid, Spain
University of Alcalá, Madrid, Spain

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). Patients with PA have a higher cardiometabolic risk profile, with four times increased risk for stroke and six times for nonfatal myocardial infarction, than patients with essential hypertension (EHT) matched by blood pressure (BP), sex, and age ( 2 , 3

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Ling Hu Department of Endocrinology, The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China

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Ting Li Department of Endocrinology, The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China

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Xiao-Ling Yin Department of Endocrinology, The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China

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Yi Zou Department of Endocrinology, The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China

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participants, including medical history, family history of chronic diseases, current medication use, and smoking and drinking status. Each patient’s height, weight, and blood pressure were measured based on standardized protocols. Blood pressure of the right

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