Searchable abstracts of presentations at key conferences in endocrinology
Endocrine Abstracts (2012) 29 P58

ICEECE2012 Poster Presentations Adrenal cortex (113 abstracts)

Treatment with mineralocorticoid receptor antagonists in ‘subclinical’ cases with adrenal adenomas and autonomous aldosterone secretion

L. Papanastasiou , T. Pappa , P. Tsounas , V. Tsiavos , A. Markou , E. Tseniklidi , M. Anastasakou , S. Fountoulakis , A. Prevoli & G. Piaditis

‘G. Gennimatas’ General Hospital, Athens, Greece.

Introduction: Patients with adrenal adenomas appear to exhibit an appreciable prevalence of autonomous aldosterone secretion (AAS). Our aim was to evaluate the anti-hypertensive effect of targeted therapy with mineralocorticoid receptor (MR) antagonists in AAS patients.

Patients and methods: We studied 60 hypertensive patients, 21 males and 39 females, harboring an adrenal adenoma with AAS. All patients were receiving combination of anti-hypertensive treatment with inadequate blood pressure (BP) control. Subjects of Conn’s syndrome were excluded. The diagnosis of AAS was established using a modified saline infusion test (MSI), i.e. saline infusion after dexamethasone administration. Cut-off levels were developed using 72 normotensive controls with normal adrenal imaging (post MSI aldosterone levels 67 pmol/l). Following hormonal evaluation, patients were switched to receive aldosterone antagonist treatment (spironolactone or eplerenone) and followed up for eight weeks. Self-reported systolic and diastolic BP values were recorded before and after treatment modification.

Results: The mean (S.D.) age of our study population was 54.80 (10.35) years and the body mass index 30.35 (4.33) kg/m2. The serum potassium concentration was 3.8 (0.4) mEq/l and the post MSI aldosterone levels 226.7 (214.1) pmol/l. The use of MSI led to the identification of 30/60 AAS patients that would be undiagnosed using the Endocrine Society guidelines. Treatment with MR antagonists resulted in a marked decrease of maximum BP values (systolic BP: 161.4 (23.6) after vs 126.3 (10.2) mmHg before and diastolic BP: 97.9 (12.5) after vs 79.7 (7.4) mmHg before respectively, P<0.001 in both cases; Fig. 1).

Conclusions: We showed a remarkable anti-hypertensive effect of MR antagonists in adrenal adenoma patients with AAS. These patients would have been unrecognized without the use of the recently proposed cut-offs for AAS diagnosis. Our findings await validation with further cohorts. Targeted therapy is expected not only to adequately control BP, but also reduce the adverse aldosterone-mediated cardiovascular actions.

Figure 1 Minimum (MIN) and maximum (MAX) SBP and DBP values before (B) and on mineralocorticoid receptor antagonist treatment (A) in 60 patients with AAS, P<0.001 in all cases. SBP: systolic blood pressure, DBP: diastolic blood pressure.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.


Volume 29

15th International & 14th European Congress of Endocrinology

European Society of Endocrinology 

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