The Spectrum of Dysregulated Aldosterone Production : An International Human Physiology Study
© The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For permissions, please e-mail: journals.permissionsoup.com..
CONTEXT: Primary aldosteronism is a form of low-renin hypertension characterized by dysregulated aldosterone production.
OBJECTIVE: To investigate the contributions of renin-independent aldosteronism, and ACTH-mediated aldosteronism, in individuals with a low-renin phenotype representing the entire continuum of blood pressure..
DESIGN/PARTICIPANTS: Human physiology study of 348 participants with a low-renin phenotype with severe and/or resistant hypertension, hypertension with hypokalemia, elevated blood pressure and stage I/II hypertension, and normal blood pressure.
SETTING: 4 international centers..
INTERVENTIONS/MAIN OUTCOME MEASURES: Saline suppression test (SST) to quantify the magnitude of renin-independent aldosteronism; dexamethasone suppression and ACTH-stimulation tests to quantify the magnitude of ACTH-mediated aldosteronism; adrenal venous sampling to determine lateralization.
RESULTS: There was a continuum of non-suppressible and renin-independent aldosterone production following SST that paralleled the magnitude of the blood pressure continuum and transcended conventional diagnostic thresholds. In parallel, there was a full continuum of ACTH-mediated aldosteronism wherein post-SST aldosterone levels were strongly correlated with ACTH-stimulated aldosterone production (r = 0.75, P < 0.0001) and non-suppressible aldosterone production post-dexamethasone (r = 0.40, P < 0.0001). Beyond participants who met criteria for primary aldosteronism (post-SST aldosterone of ≥10 ng/dL or ≥277 pmol/L), the continuum of non-suppressible and renin-independent aldosterone production persisted below this diagnostic threshold, wherein 15% still had lateralizing aldosteronism amenable to surgical adrenalectomy, and the remainder were treated with mineralocorticoid receptor antagonists.
CONCLUSIONS: In the context of a low-renin phenotype, there is a continuum of dysregulated aldosterone production that is prominently influenced by ACTH. A large proportion of individuals with low-renin have dysregulated aldosterone production and may benefit from aldosterone-directed therapy.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - year:2024 |
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| Enthalten in: |
The Journal of clinical endocrinology and metabolism - (2024) vom: 07. März |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Parksook, Wasita W [VerfasserIn] |
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| Links: |
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| Themen: |
ACTH |
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| Anmerkungen: |
Date Revised 07.03.2024 published: Print-Electronic Citation Status Publisher |
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| doi: |
10.1210/clinem/dgae145 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM369403118 |
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| 100 | 1 | |a Parksook, Wasita W |e verfasserin |4 aut | |
| 245 | 1 | 4 | |a The Spectrum of Dysregulated Aldosterone Production |b An International Human Physiology Study |
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| 500 | |a Date Revised 07.03.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status Publisher | ||
| 520 | |a © The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For permissions, please e-mail: journals.permissionsoup.com. | ||
| 520 | |a CONTEXT: Primary aldosteronism is a form of low-renin hypertension characterized by dysregulated aldosterone production | ||
| 520 | |a OBJECTIVE: To investigate the contributions of renin-independent aldosteronism, and ACTH-mediated aldosteronism, in individuals with a low-renin phenotype representing the entire continuum of blood pressure. | ||
| 520 | |a DESIGN/PARTICIPANTS: Human physiology study of 348 participants with a low-renin phenotype with severe and/or resistant hypertension, hypertension with hypokalemia, elevated blood pressure and stage I/II hypertension, and normal blood pressure | ||
| 520 | |a SETTING: 4 international centers. | ||
| 520 | |a INTERVENTIONS/MAIN OUTCOME MEASURES: Saline suppression test (SST) to quantify the magnitude of renin-independent aldosteronism; dexamethasone suppression and ACTH-stimulation tests to quantify the magnitude of ACTH-mediated aldosteronism; adrenal venous sampling to determine lateralization | ||
| 520 | |a RESULTS: There was a continuum of non-suppressible and renin-independent aldosterone production following SST that paralleled the magnitude of the blood pressure continuum and transcended conventional diagnostic thresholds. In parallel, there was a full continuum of ACTH-mediated aldosteronism wherein post-SST aldosterone levels were strongly correlated with ACTH-stimulated aldosterone production (r = 0.75, P < 0.0001) and non-suppressible aldosterone production post-dexamethasone (r = 0.40, P < 0.0001). Beyond participants who met criteria for primary aldosteronism (post-SST aldosterone of ≥10 ng/dL or ≥277 pmol/L), the continuum of non-suppressible and renin-independent aldosterone production persisted below this diagnostic threshold, wherein 15% still had lateralizing aldosteronism amenable to surgical adrenalectomy, and the remainder were treated with mineralocorticoid receptor antagonists | ||
| 520 | |a CONCLUSIONS: In the context of a low-renin phenotype, there is a continuum of dysregulated aldosterone production that is prominently influenced by ACTH. A large proportion of individuals with low-renin have dysregulated aldosterone production and may benefit from aldosterone-directed therapy | ||
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| 650 | 4 | |a primary aldosteronism | |
| 700 | 1 | |a Brown, Jenifer M |e verfasserin |4 aut | |
| 700 | 1 | |a Omata, Kei |e verfasserin |4 aut | |
| 700 | 1 | |a Tezuka, Yuta |e verfasserin |4 aut | |
| 700 | 1 | |a Ono, Yoshikiyo |e verfasserin |4 aut | |
| 700 | 1 | |a Satoh, Fumitoshi |e verfasserin |4 aut | |
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| 700 | 1 | |a Milks, Julia |e verfasserin |4 aut | |
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| 700 | 1 | |a Honzel, Brooke |e verfasserin |4 aut | |
| 700 | 1 | |a Liu, Haiping |e verfasserin |4 aut | |
| 700 | 1 | |a Auchus, Richard J |e verfasserin |4 aut | |
| 700 | 1 | |a Sunthornyothin, Sarat |e verfasserin |4 aut | |
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