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 SUN-176 A Case of Aldosterone-Producing Adenoma with Preoperative Use of a Novel Mineralocorticoid Receptor Antagonist Esaxerenone

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Hiroaki Yamanami
Keyword(s):  
Blood Pressure ◽  
Receptor Antagonist ◽  
Primary Aldosteronism ◽  
Mineralocorticoid Receptor ◽  
Adrenal Venous Sampling ◽  
Venous Sampling ◽  
Mineralocorticoid Receptor Antagonist ◽  
Plasma Aldosterone Concentration ◽  
Potassium Supplementation ◽  
Aldosterone Producing Adenoma

Abstract Background: Esaxerenone is a novel mineralocorticoid receptor antagonist (MRA) with nonsteroidal structure and high selectivity to MR, which became clinically available in Japan in 2019. Clinical Case: A 57-year-old woman showed a left adrenal incidentaloma (15mm) on MRI. Serological tests confirmed a diagnosis of primary aldosteronism: baseline plasma aldosterone concentration (PAC) was elevated (47.3 ng/dL, n < 15.9 ng/dL), and plasma renin activity (PRA) below sensitivity. PAC after saline infusion was 43.2 ng/dL. Overnight 1mg dexamethasone suppression test was negative. Her blood pressure had been well-controlled with amlodipine 5mg daily. Despite of large amount of potassium supplementation (96 mmol/day orally and 50 mmol/day intravenously), the level of serum potassium remained low (3.2 mmol/L). Adrenal venous sampling (AVS) was performed successfully, showing laterality index of 45.8 on left. Segmental AVS supported aldosterone hypersecretion from the tumor. After diagnosis, esaxerenone was introduced and the patient became normokalemic without potassium supplementation after a week. No adverse effect occurred in a period of two months before surgery. She underwent laparoscopic left total adrenalectomy. The tumor was positive for CYP11B2, consistent with aldosterone producing adenoma (APA). She became normotensive and normokalemic without any medications. Conclusion: This case illustrates the preoperative effectiveness of esaxerenone on blood pressure and hypokalemia in patients with APA. Key words: Esaxerenone; mineralocorticoid receptor antagonist; case report; adrenal venous sampling; primary aldosteronism; aldosterone producing adenoma

Mean platelet volume in patients with primary aldosteronism and its relation to left ventricular hypertrophy

2013 ◽  
Vol 168 (3) ◽  
pp. 3143-3144 ◽  
Author(s):  
Satoshi Kurisu ◽  
Takashi Shimonaga ◽  
Toshitaka Iwasaki ◽  
Naoya Mitsuba ◽  
Ken Ishibashi ◽  
...  
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Primary Aldosteronism ◽  
Mean Platelet Volume ◽  
Ventricular Hypertrophy ◽  
Left Ventricular ◽  
Platelet Volume

Voltage Disturbances During Pregnancy

2017 ◽  
Author(s):  
Heather C. Nixon
Keyword(s):  
Ventricular Tachycardia ◽  
Left Ventricular Hypertrophy ◽  
Ventricular Hypertrophy ◽  
Well Being ◽  
Left Ventricular ◽  
Ventricular Ectopy ◽  
Conversion Therapy ◽  
St Segment ◽  
Assessment And Treatment ◽  
The Impact

This chapter covers the incidence, etiology, and treatment of the most common electrocardiogram and rhythm disturbances encountered during pregnancy. Baseline electrocardiogram changes associated with pregnancy include left ventricular hypertrophy and ST segment depressions secondary to anatomic and metabolic changes of pregnancy. The most common arrhythmias include atrial and ventricular ectopy, which are usually benign in nature. Supraventricular and ventricular tachycardia are also discussed in detail, along with the impact of antiarrhythmic and electrical conversion therapy on fetal and maternal well-being. An understanding of the pathophysiology, assessment, and treatment of these rhythm disturbances is requisite knowledge for all anesthesiologists to provide optimal and timely care to parturients.

scholarly journals Uric acid and left ventricular hypertrophy: another relationship in hemodialysis patients

2019 ◽  
Author(s):  
Gjulsen Selim ◽  
Olivera Stojceva-Taneva ◽  
Liljana Tozija ◽  
Beti Zafirova-Ivanovska ◽  
Goce Spasovski ◽  
...  
Keyword(s):  
Uric Acid ◽  
General Population ◽  
Left Ventricular Hypertrophy ◽  
Ventricular Hypertrophy ◽  
Reference Group ◽  
Left Ventricular ◽  
Reactive Protein ◽  
Cv Disease ◽  
The Impact

Abstract Background The impact of serum uric acid (UA) on morbidity and mortality in hemodialysis (HD) patients is quite controversial in relation to the general population. The aim of this study was to evaluate the association of serum UA with both mortality and left ventricular hypertrophy (LVH) in HD patients. Methods This longitudinal study enrolled 225 prevalent HD patients who were classified into three groups according to their follow-up-averaged UA (FA-UA) levels: low FA-UA (FA-UA <400 µmol/L), intermediate/reference FA-UA (FA-UA between 400 and 450 µmol/L) and high FA-UA (FA-UA >450 µmol/L). Echocardiography was performed on a nondialysis day and the presence of LVH was defined based on a left ventricular mass index (LVMI) >131 and >100 g/m2 for men and women, respectively. The patients were followed during a 60-month period. Results The mean FA-UA level was 425 ± 59 µmol/L (range 294–620). There was a consistent association of higher FA-UA with better nutritional status (higher body mass index, normalized protein catabolic rate, creatinine, albumin and phosphorus), higher hemoglobin, but lower C-reactive protein and LVMI. During the 5-year follow-up, 81 patients died (36%) and the main causes of death were cardiovascular (CV) related (70%). When compared with the reference group, the hazard ratio for all-cause mortality was 1.75 [95% confidence interval (CI) 1.02–2.98; P = 0.041] in the low FA-UA group, but there was no significant association with the high FA-UA group. In contrast, FA-UA did not show an association with CV mortality neither with the lower nor with the high FA-UA group. The unadjusted odds ratio (OR) of LVH risk in the low FA-UA compared with the reference FA-UA group was 3.11 (95% CI 1.38–7.05; P = 0.006), and after adjustment for age, gender, diabetes and CV disease, ORs for LVH persisted significantly only in the low FA-UA group [OR 2.82 (95% CI 1.16–6.88,); P = 0.002]. Conclusions Low serum UA is a mortality risk factor and is associated with LVH in HD patients. These results are in contrast with the association of UA in the general population and should be the subject of further research.

scholarly journals Left Ventricular Hypertrophy Is More Prominent in Patients with Primary Aldosteronism than in Patients with Other Types of Secondary Hypertension.

1997 ◽  
Vol 20 (2) ◽  
pp. 85-90 ◽  
Author(s):  
Akiyo Tanabe ◽  
Mitsuhide Naruse ◽  
Kiyoko Naruse ◽  
Mitsuyasu Hase ◽  
Takanobu Yoshimoto ◽  
...  
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Primary Aldosteronism ◽  
Ventricular Hypertrophy ◽  
Secondary Hypertension ◽  
Left Ventricular
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