Mineralocorticoid Receptor Antagonist Effect on Aldosterone to Renin Ratio in Patients With Primary Aldosteronism
| Autor: | Giulio Mengozzi, Valeria Avataneo, Paolo Mulatero, Franco Rabbia, Silvia Monticone, Jacopo Burrello, Fabrizio Buffolo, Franco Veglio, Alessio Pecori, Francesca Rumbolo, Antonio D'Avolio, Chiara Bertello |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent Endocrinology Diabetes and Metabolism Clinical Biochemistry Urology Guidelines as Topic Context (language use) Biochemistry Medication Adherence Cohort Studies Young Adult chemistry.chemical_compound Endocrinology Primary aldosteronism Mineralocorticoid receptor Canrenone Internal medicine Hyperaldosteronism Renin Renin–angiotensin system medicine Humans Mass Screening Prospective Studies Aldosterone False Negative Reactions Aged Mineralocorticoid Receptor Antagonists aldosterone canrenone hypertension Mineralocorticoid receptor antagonists primary aldosteronism renin Adrenalectomy Female Hypertension Middle Aged Potassium Reproducibility of Results Aldosterone-to-renin ratio business.industry Biochemistry (medical) medicine.disease chemistry business medicine.drug Hormone |
| Zdroj: | The Journal of Clinical Endocrinology & Metabolism. 106:e3655-e3664 |
| ISSN: | 1945-7197 0021-972X |
| DOI: | 10.1210/clinem/dgab290 |
| Popis: | Context Although current international guidelines recommend to avoid mineralocortcoid receptor antagonists in patients undergoing screening test for primary aldosteronism, a recent report suggested that mineralocorticoid receptor antagonist treatment can be continued without significant influence on screening results. Objective We aimed to evaluate the effect of mineralocorticoid receptor antagonists on the aldosterone to renin ratio in patients with primary aldosteronism. Methods We prospectively enrolled 121 patients with confirmed primary aldosteronism who started mineralocorticoid receptor antagonist (canrenone) treatment. Eighteen patients (11 with unilateral and 7 with bilateral primary aldosteronism) constituted 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 the 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 was raised to 16.7%, 38.9%, 54.5%, and 72.5% after 2 weeks, 8 weeks, 2 to 6 months, and 7 to 12 months of mineralocorticoid receptor antagonist treatment, respectively. Conclusion Mineralocorticoid receptor antagonists should be avoided in patients with hypertension before measurement of renin and aldosterone for screening of primary aldosteronism. |
| Databáze: | OpenAIRE |
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