Increased serum aldosterone in diabetic pregnancy

Cugini, P; Letizia, Claudio; Murano, G; Lucia, P; Scavo, D; Gerlini, G; Negri, M; Fallucca, F.

doi:10.1007/bf00274222

Cited by 6 publications

(3 citation statements)

References 9 publications

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“…The non-pregnant reference range of renin, according to manufacturer's data, was established on a cohort that included only 40 women (aged 18-65 years). Previous studies on aldosterone and renin (or plasma renin activity) in pregnancy were also based on smaller or similar cohorts, e. g. of seven [18], 36 [19], or 56 women [20]. Mean third-trimester concentrations of aldosterone obtained in our study were lower than those obtained by Bentley-Lewis et al [27] ( 29.38 ± 16.97 ng/dl versus 81.1 ± 6.8 ng/ dl, and 37.18 ± 19.79 ng/dl versus 112.7 ± 8.6 ng/dl, for supine and upright posture, respectively), but our data are based on a larger number of pregnant women (n = 70 versus n = 24).…”

Section: Discussionmentioning

confidence: 99%

“…Although plasma aldosterone and renin concentrations increase during pregnancy, the diagnosis of primary hyperaldosteronism in pregnancy is complicated given that formal reference ranges were either not established, e. g. Ledoux et al 18 and Cugini et al 19 , or alternatively, the data were based on radioimunoassays that are no longer used, e. g. Vulkova et al 20 .…”

Section: Discussionmentioning

confidence: 99%

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Establishing Reference Ranges for Aldosterone, Renin and Aldosterone-to-Renin Ratio for Women in the Third-Trimester of Pregnancy

Lewandowski

Tadros-Zins

Horzelski

et al. 2022

Exp Clin Endocrinol Diabetes

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Objective Diagnosis of primary hyperaldosteronism in pregnancy is complicated due to lack of reference ranges for aldosterone, renin and aldosterone-to-renin ratio. We have endeavoured to establish third-trimester reference ranges for the above-mentioned parameters. Design & Patients We performed postural tests for aldosterone and renin (chemiluminescence immunoassay Liason® DiaSorin Inc., Italy) in 70 healthy pregnant women (age 30.53±4.51 years), at 32.38±4.25 weeks of gestation and in 22 non-pregnant healthy women (age 33.08±8.72 years). Results Aldosterone reference ranges were 6.51–73.97 ng/dl and 12.33–86.38 ng/dl, for supine and upright positions, respectively and that for renin were 6.25–59.36 µIU/ml and 11.12–82.55 µIU/ml, respectively. Aldosterone and renin concentrations were higher in an upright position (p=0.000459 and p=0.00011, respectively). In contrast, aldosterone-to-renin ratio was not affected by posture (i. e. 0.497–3.084 ng/dl/µIU/ml versus 0.457–3.06 ng/dl/µIU/ml, p=0.12), but was higher (p=0.00081) than in non-pregnant controls. In comparison to manufacturer-provided non-pregnant reference range, supine aldosterone concentrations increased by 556% (lower cut-off) and 313% (upper cut-off), while upright aldosterone concentrations increased by 558% (lower cut-off) and 244% (upper cut-off). The reference range for supine renin concentrations increased by 223% (lower cut-off) and 48.7% (upper cut-off), while upright renin concentrations increased by 253% (lower cut-off) and 79% (upper cut-off). Conclusions There is an upward shift in aldosterone and renin reference ranges in the third-trimester of pregnancy accompanied by an increase in an aldosterone-to-renin ratio, that is not influenced by posture. It remains to be established whether the aldosterone-to-renin ratio may be used as a screening tool for primary hyperaldosteronism in pregnancy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Establishing Reference Ranges for Aldosterone, Renin and Aldosterone-to-Renin Ratio for Women in the Third-Trimester of Pregnancy

Lewandowski

Tadros-Zins

Horzelski

et al. 2022

Exp Clin Endocrinol Diabetes

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“…Conliffe and Mulay [12] observed that fetal rat plasma corticosterone appeared to be related to the degree of hyperglycemia. Cugini et al [27] have reported elevated aldosterone levels in the newborns of human diabetics.…”

Section: Discussionmentioning

confidence: 99%

Adrenocortical Imprint in the Fetus of a Diabetic Gestation

Malee

Wu²

1999

Neonatology

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Offspring of diabetics are at increased risk for diabetes as adults. As corticosteroids are intimately involved in glucose homeostasis, we investigated aspects of corticosteroid activity in the late gestation fetuses of control, moderately diabetic and insulin-controlled streptozotocin-induced diabetic rats. We found that moderate maternal diabetes had no effect upon litter size or fetal body weight. Uncontrolled maternal diabetes was accompanied by fetal hyperglycemia, hyperinsulinemia and elevated aldosterone. Maternal insulin treatment normalized fetal glucose and aldosterone; fetal insulin and corticosterone levels increased. Maternal diabetes had no effect upon fetal adrenal expression of P450scc mRNA; the abundance of P450c11β mRNA increased, and returned to that of the control gestation upon insulin treatment. P450c11AS mRNA was barely detectable, and decreased in the fetuses of insulin-treated diabetics. P450c11B3 mRNA was undetectable in all fetal groups. Our results implicate aspects of maternal diabetes in the expression of a fetal adrenocortical imprint, manifested as a greater abundance of P450c11β mRNA. Although not accompanied by elevated corticosterone in the fetus, this imprint could ultimately allow for greater potential corticosterone production in response to typical stimuli, and thus contribute to the tendency towards glucose dysregulation in these offspring of diabetic gestations.

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