scholarly journals Adequate salt intake attenuates mineralocorticoid receptor antagonist-induced hyperkalemia in patients with primary aldosteronism

2016 ◽  
Author(s):  
Stelios Fountoulakis ◽  
Labrini Papanastasiou ◽  
George Piaditis
Keyword(s):  
Receptor Antagonist ◽  
Primary Aldosteronism ◽  
Mineralocorticoid Receptor ◽  
Salt Intake ◽  
Mineralocorticoid Receptor Antagonist

Salt intake in mineralocorticoid receptor antagonist-treated primary aldosteronism: foe or ally?

HORMONES ◽  
2019 ◽  
Vol 19 (2) ◽  
pp. 223-232
Author(s):  
Stelios Fountoulakis ◽  
Labrini Papanastasiou ◽  
Nikos Voulgaris ◽  
Theodora Kounadi ◽  
Athina Markou ◽  
...  
Keyword(s):  
Receptor Antagonist ◽  
Primary Aldosteronism ◽  
Mineralocorticoid Receptor ◽  
Salt Intake ◽  
Mineralocorticoid Receptor Antagonist

Mineralocorticoid receptor antagonist effect on aldosterone to renin ratio in patients with primary aldosteronism

2021 ◽  
Author(s):  
Alessio Pecori ◽  
Fabrizio Buffolo ◽  
Jacopo Burrello ◽  
Giulio Mengozzi ◽  
Francesca Rumbolo ◽  
...  
Keyword(s):  
Receptor Antagonist ◽  
Primary Aldosteronism ◽  
Mineralocorticoid Receptor ◽  
Study Cohort ◽  
Mineralocorticoid Receptor Antagonists ◽  
Receptor Antagonists ◽  
Mineralocorticoid Receptor Antagonist ◽  
Long Term Treatment ◽  
Aldosterone To Renin Ratio

Abstract Purpose We aimed to evaluate the effect of mineralocorticoid receptor antagonists on aldosterone-to-renin ratio in patients with primary aldosteronism. Methods We prospectively enrolled 121 patients with confirmed primary aldosteronism who started a mineralocorticoid receptor antagonist (canrenone) treatment. Eighteen patients (11 with unilateral and 7 with bilateral primary aldosteronism) composed the short-term study cohort and underwent aldosterone, renin and potassium measurement after 2 and 8 weeks of canrenone therapy. The long-term cohort comprised 102 patients (16 with unilateral and 67 with bilateral primary aldosteronism, and 19 with undetermined subtype) who underwent hormonal and biochemical re-assessment after 2 to 12 months of canrenone therapy. Results Renin and potassium levels showed a significant increase, and aldosterone-to-renin ratio displayed a significant reduction compared with baseline after both a short and long-term treatment. These effects were progressively more evident with higher doses of canrenone and after longer periods of treatment. We demonstrated that canrenone exerted a deep impact on the diagnostic accuracy of the screening test for primary aldosteronism: the rate of false negative tests raised to 16.7%, 38.9%, 54.5% and 72.5% after 2 weeks, 8 weeks, 2-6 months and 7-12 months of mineralocorticoid receptor antagonist treatment, respectively. Conclusions Mineralocorticoid receptor antagonists should be avoided in patients with hypertension before measurement of renin and aldosterone for screening of primary aldosteronism.

scholarly journals Cortisol Excess in Patients With Primary Aldosteronism Impacts Left Ventricular Hypertrophy

2018 ◽  
Vol 103 (12) ◽  
pp. 4543-4552 ◽  
Author(s):  
Christian Adolf ◽  
Anton Köhler ◽  
Anna Franke ◽  
Katharina Lang ◽  
Anna Riester ◽  
...  
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Receptor Antagonist ◽  
Cardiac Remodeling ◽  
Primary Aldosteronism ◽  
Mineralocorticoid Receptor ◽  
Ventricular Hypertrophy ◽  
Left Ventricular ◽  
Mineralocorticoid Receptor Antagonist ◽  
Aldosterone Producing Adenoma ◽  
The Impact

Abstract Context Primary aldosteronism (PA) represents the most frequent form of endocrine hypertension. Hyperaldosteronism and hypercortisolism both induce excessive left ventricular hypertrophy (LVH) compared with matched essential hypertensives. In recent studies frequent cosecretion of cortisol and aldosterone has been reported in patients with PA. Objective Our aim was to investigate the impact of cortisol cosecretion on LVH in patients with PA. We determined 24-hour excretion of mineralocorticoids and glucocorticoids by gas chromatography–mass spectrometry and assessed cardiac remodeling using echocardiography initially and 1 year after initiation of treatment of PA. Patients We included 73 patients from the Munich center of the German Conn’s registry: 45 with unilateral aldosterone-producing adenoma and 28 with bilateral adrenal hyperplasia. Results At the time of diagnosis, 85% of patients with PA showed LVH according to left ventricular mass index [(LVMI); median 62.4 g/m2.7]. LVMI correlated positively with total glucocorticoid excretion (r2 = 0.076, P = 0.018) as well as with tetrahydroaldosterone excretion (r2 = 0.070, P = 0.024). Adrenalectomy led to significantly reduced LVMI in aldosterone-producing adenoma (P < 0.001) whereas mineralocorticoid receptor antagonist therapy in bilateral adrenal patients with hyperplasia reduced LVMI to a lesser degree (P = 0.024). In multivariate analysis, the decrease in LVMI was positively correlated with total glucocorticoid excretion and systolic 24-hour blood pressure, but not with tetrahydroaldosterone excretion. Conclusion Cortisol excess appears to have an additional impact on cardiac remodeling in patients with PA. Treatment of PA by either adrenalectomy or mineralocorticoid receptor antagonist improves LVMI. This effect was most pronounced in patients with high total glucocorticoid excretion.

scholarly journals Time-Dependent Risk of Atrial Fibrillation in Patients With Primary Aldosteronism After Medical or Surgical Treatment Initiation

Hypertension ◽  
2021 ◽  
Author(s):  
Kyoung Jin Kim ◽  
Namki Hong ◽  
Min Heui Yu ◽  
Hokyou Lee ◽  
Seunghyun Lee ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Essential Hypertension ◽  
Receptor Antagonist ◽  
Primary Aldosteronism ◽  
Mineralocorticoid Receptor ◽  
Time Dependent ◽  
Mineralocorticoid Receptor Antagonist ◽  
Increased Risk ◽  
Onset Atrial Fibrillation ◽  
New Onset

Increased risk of atrial fibrillation was reported in patients with primary aldosteronism. However, data are limited regarding the time-dependent risk of atrial fibrillation in surgically or medically treated primary aldosteronism. From the National Health Insurance Claim database in Korea (2003–2017), a total of 1418 patients with primary aldosteronism (adrenalectomy [ADX], n=755, mineralocorticoid receptor antagonist n=663) were age- and sex-matched at a 1:5 ratios to patients with essential hypertension (n=7090). Crude incidence of new onset atrial fibrillation was 2.96% in primary aldosteronism and 1.97% in essential hypertension. Because of nonproportional hazard observed in new onset atrial fibrillation, analysis time was split at 3 years. Compared with essential hypertension, risk of new onset atrial fibrillation peaked at 1 year gradually declined but remained elevated up to 3 years in overall treated primary aldosteronism (adjusted hazard ratio [aHR] 3.02; P <0.001) as well as in both ADX (aHR, 3.54; P <0.001) and mineralocorticoid receptor antagonist groups (aHR 2.27; P =0.031), which became comparable to essential hypertension afterward in both groups (ADX aHR, 0.38; P =0.102; mineralocorticoid receptor antagonist aHR, 0.60; P =0.214). Nonetheless, mineralocorticoid receptor antagonist group was associated with increased risk of nonfatal stroke (aHR, 1.21; P =0.031) compared with essential hypertension, whereas ADX was not (aHR, 1.26; P =0.288). Our results suggest the risk of new-onset atrial fibrillation remained elevated up to 3 years in treated primary aldosteronism compared with essential hypertension, which declined to comparable risk in essential hypertension thereafter. Monitoring for atrial fibrillation up to 3 years after treatment, particularly ADX, might be warranted.

scholarly journals Sex Differences in Renal Outcomes After Medical Treatment for Bilateral Primary Aldosteronism

Hypertension ◽  
2020 ◽  
Author(s):  
Ryo Nakamaru ◽  
Koichi Yamamoto ◽  
Hiroshi Akasaka ◽  
Hiromi Rakugi ◽  
Isao Kurihara ◽  
...  
Keyword(s):  
Glomerular Filtration Rate ◽  
Receptor Antagonist ◽  
Primary Aldosteronism ◽  
Mineralocorticoid Receptor ◽  
Filtration Rate ◽  
Estimated Glomerular Filtration Rate ◽  
Late Phase ◽  
Mineralocorticoid Receptor Antagonist ◽  
Renal Outcomes ◽  
Annual Decline

A higher incidence of bilateral primary aldosteronism in women is reported. Treatment of bilateral primary aldosteronism usually involves mineralocorticoid receptor antagonists. However, the impact of sex on renal outcomes is unknown. We compared renal outcomes between the sexes after mineralocorticoid receptor antagonist initiation by analyzing data obtained from 415 female and 313 male patients with bilateral primary aldosteronism who were treated with spironolactone or eplerenone in the JPAS (Japan Primary Aldosteronism Study). Over the course of 5 years, the temporal reduction in the estimated glomerular filtration rate was greater in women than in men ( P <0.001). Systolic blood pressure levels were equal between the sexes, despite higher doses of antihypertensive drugs in men. The mean of the annual decline in estimated glomerular filtration rate during what we termed the late phase, or 6 to 60 months after mineralocorticoid receptor antagonist initiation, was larger in women than in men after adjusting for patient characteristics (−1.33 mL/min per 1.73 m 2 per year versus −1.04 mL/min per 1.73 m 2 per year, P <0.01). Female sex was a significant predictor of greater annual decline during the late phase in patients taking spironolactone but not in those taking eplerenone. Spironolactone use and diabetes were independent predictors of a greater annual decline in estimated glomerular filtration rate during the late phase in women. These findings suggest that female sex is associated with poorer renal outcomes in patients receiving mineralocorticoid receptor antagonist for bilateral primary aldosteronism.

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