LEP and metabolic syndrome: Regarding the pathophysiological mechanisms that can influence the development of metabolic alterations observed in patients with PA, we previously highlighted how altered balance between some important adipocytokines (an increase of leptin and resistin; and reduction of adiponectin) was related to the increased prevalence of metabolic syndrome and important cardiac remodeling (increased LVM, left atrium, and left ventricular end-diastolic volume; and reduction of ejection fraction) (3, 50).