Background: Despite adequate glucocorticoid (GC) and mineralocorticoid (MC) replacement therapy, primary adrenal insufficiency (AI) is associated with an increased mortality, mainly due to cardiovascular disease. The role of MC replacement is not known. Therefore we assessed whether renin concentrations during routine GC and MC substitution therapy are associated with cardiac function and morphology.
Methods: 17 patients with AI underwent magnetic resonance (MR) spectroscopy and imaging measurements to assess cardiac function and morphology, ectopic lipid content in myocardium and liver, pericardial fat mass and the ratio of visceral/subcutaneous fat mass. Additionally, blood was drawn to investigate glucose and lipid metabolism. They were compared to 34 healthy controls matched for age and BMI. Patients were divided according to their actual plasma renin concentration at the study visit (Actual-Reninlow vs Actual-Reninhigh) and their median plasma renin concentration of previous visits (Median-Reninlow vs Median-Reninhigh).
Results: Ejection fraction was higher (67±5 vs 55±3%; P=0.001) and left ventricular mass was lower (60±9 vs 73±10 g/m2; P=0.025) in Actual-Reninhigh. Median-Reninhigh was associated with lower cardiac mass (64±9 vs 76±11 g/m2; P=0.029). Blood pressure, glucose and lipid metabolism, as well as ectopic lipid content, pericardial fat mass and visceral/subcutaneous fat were not different between the groups. Compared to controls ejection was significantly lower in patients with AI (56±4 vs 63±8%; P=0.019). No differences were found in patients with ≤ 20 mg compared to > 20 mg hydrocortisone per day.
Conclusions: Higher renin concentrations are associated with more favorable cardiac function and morphology in patients with primary AI.
18 - 21 May 2019
European Society of Endocrinology