New Mechanisms to Control Aldosterone Synthesis

Willenberg, Holger S.; Schinner, Sven; Ansurudeen, Ishrath

doi:10.1055/s-2008-1065336

Cited by 55 publications

(44 citation statements)

References 67 publications

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“…Many patients with PA have a suppressed PRA, with values below 1 ng ml À1 h À1 , therefore enhancing the A PL /PRA ratio. 14,17 The good accuracy of ARR is confirmed by other studies, in which plasma renin concentration was used with 1 ng l À1 as lower detection limit of the laboratory assay. 37 The same principle was applied for A UR /R ratio.…”

Section: Discussionsupporting

confidence: 55%

“…closely in EH than in PA. Consequently, BBL/Clon treatment did not significantly interfere with the SUSPPUP ratio, because aldosterone secretion occurs to some extent independent of renin in PA. 14 Patients under HCT therapy had higher renin levels than those who were not and aldosterone followed renin levels in EH patients but not in patients with PA, resulting in a lower ARR in PA patients, while the ARR remained stable in EH patients. Interestingly, the SUSPPUP ratios were not different between the treatment groups, thus indicating that HCT does not favor kaliuresis over natriuresis.…”

Section: Discussionmentioning

confidence: 85%

“…1 Overall, the predictive value of the ARR is hampered, as aldosterone is also regulated by factors other than angiotensin II and normal values of A PL can be amplified by very low PRA levels, leading to a high A PL /PRA ratio. 14 As stated by Young and others, if A PL is included as a second screening test the accuracy increases. 15,16 The logistic regression model developed, based on A PL and PRA, showed a good sensitivity and specificity.…”

Section: Introductionmentioning

confidence: 89%

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Indicators of mineralocorticoid excess in the evaluation of primary aldosteronism

et al. 2010

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It is suggested to use the aldosterone-to-renin ratio (ARR) as a first test in the screening for primary aldosteronism (PA). However, many groups rather rely on the determination of urinary tetrahydroaldosterone secretion; others calculate a ratio of urinary aldosterone to plasma renin activity. The aim of the present study was to evaluate the usefulness of different parameters of aldosterone excess in the case finding of PA. The study included 28 patients with PA and 33 subjects with essential hypertension. Clinical data, which included the hormonal parameters, serum aldosterone, plasma renin concentration, urinary free aldosterone and metabolites and serum and urinary electrolyte levels were analyzed. These indices of aldosterone excess, the ARR, serum sodium to urinary sodium to (serum potassium) 2 to urinary potassium (SUSPPUP) ratio and combinations of these parameters were compared between the groups. Receiver-operating curve analysis revealed that the ARR multiplied by the SUSPPUP ratio (ARRÂSUSPPUP) is the most reliable screening test, with a sensitivity of 92.3% and a specificity of 93.9% (cutoff point 199.2 (mmol l À1 ) À1 ). The combination of ARRÂSUSPPUP ratio with urinary free aldosterone divided by the plasma renin concentration rendered a specificity of 100%. Less useful was the correction of urinary free aldosterone and its metabolites for sodium excretion. Although the ARR and urinary free aldosterone divided by renin are good tests in the screening for PA, the combination of ARR with SUSPPUP ratio is a better indicator of an aldosterone excess and aldosterone action in patients with ongoing antihypertensive medication. Antihypertensive drugs only marginally interfere with the SUSPPUP ratio, but they may influence the ARR, whereby the effects in PA patients seem to be negligible.

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Section: Discussionsupporting

confidence: 55%

Section: Discussionmentioning

confidence: 85%

Section: Introductionmentioning

confidence: 89%

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Indicators of mineralocorticoid excess in the evaluation of primary aldosteronism

et al. 2010

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“…In this case, an SI > 3 should be presumed, above which an LI > 4 would be sufficient indication of unilateral disease [45]. We see problems related to this, since the availability of Synacthen is currently quite limited due to the sale of production rights [47] Further, the distinction between unilateral and bilateral disease can easily be blurred, since normal adrenal tissue responds with raised aldosterone secretion after administration of ACTH [48]. Because of this, we perform AVS without ACTH stimulation at our Center.…”

mentioning

confidence: 99%

Indication and Technical Aspects of Adrenal Blood Sampling

Blondin

Quack

Kücükköylü

et al. 2014

Fortschr Röntgenstr

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Adrenal disorders are relative frequent with regard to the incidence of adrenal tumors and the high portion in causes of secondary hypertension. Morphological changes in the adrenal glands can lead to very different functional disorders that may be clinically overt or hard to diagnose. On the other hand, they can already be functionally relevant when structural changes are too small to be picked up by imaging. Adrenal venous sampling serves to determine the source of hormone excess through the analysis of adrenal blood. In this manuscript, we call attention to the clinical backgrounds, critical points in praxis, technical aspects and developments in the the field of adrenal venous sampling. The consideration of these important points in the clincal setting may make adrenal vein sampling studies sucessful and help to select patients that qualify for adrenalectomy. Key Points: ??Selective adrenal venous sampling (AVS) currently continues to be the gold standard for localization diagnostics in patients with primary hyperaldosteronism. ??Comprehensive standardization of all preceding examinations and AVS is necessary to ensure high success rates. ??The method is supported by contrast-enhanced imaging for ensuring proper positioning of the catheter in the adrenal veins and the rapid cortisol assay. ??Knowledge of the anatomy and normal variants of the adrenal veins facilitates adrenal venous sampling. Citation Format: ??Blondin D, Quack I, Haase M et?al. Indication and Technical Aspects of Adrenal Blood Sampling. Fortschr R?ntgenstr 2015; 187: 19???28

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“…In line with our findings, ECCM has been shown to stimulate adrenal cellderived aldosterone production. 4,[23][24][25] This phenomenon was neither inhibited by Ang II nor by endothelin blockers, yet was subject to proteolysis and heat inactivation 26 and could well be locally, in the ECs, produced VEGF.…”

Section: Discussionmentioning

confidence: 99%

Vascular Endothelial Growth Factor-A and Aldosterone

et al. 2013

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Abstract-Aldosterone levels are markedly elevated during normal pregnancy but fall even though volume contracts when preeclampsia occurs. The level of aldosterone in either condition cannot be explained solely by the activity of the renin-angiotensin II system. In normal gestation, vascular endothelial growth factor (VEGF) is thought to maintain vascular health, but its role in adrenal hormone production is unknown. We hypothesized that the role of VEGF in the adrenal gland is to maintain vascular health and regulate aldosterone production. Here, we demonstrate that supernatant of endothelial cells grown in the presence of VEGF enhanced aldosterone synthase activity in human adrenocortical cells. VEGF either alone or combined with angiotensin II increased aldosterone production in adrenal cells. These data suggest that endothelial cell-dependent and independent activation of aldosterone is regulated by VEGF. In contrast to angiotensin II, VEGF did not upregulate the steroidogenic acute regulatory protein. Consistent with this observation, angiotensin II stimulated both aldosterone and cortisol synthesis from progesterone, whereas VEGF stimulated selectively aldosterone production. In rats, overexpression of soluble fms-like tyrosine kinase-1, an endogenous VEGF inhibitor, led to adrenocortical capillary rarefaction and fall in aldosterone concentrations that correlated inversely with soluble fms-like tyrosine kinase-1 levels. These findings may explain why aldosterone increases so markedly during normal gestation and why preeclampsia, a condition characterized by high soluble fms-like tyrosine kinase-1, is associated with inappropriately low aldosterone levels in spite of relatively lower plasma volumes. (Hypertension. 2013;61:1111-1117.) • Online Data SupplementKey Words: adrenal cell ■ aldosterone ■ aldosterone synthase ■ preeclampsia ■ soluble fms-like tyrosine kinase-1 ■ steroidogenic acute regulatory protein ■ vascular endothelial growth factor

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New Mechanisms to Control Aldosterone Synthesis

Cited by 55 publications

References 67 publications

Indicators of mineralocorticoid excess in the evaluation of primary aldosteronism

Indicators of mineralocorticoid excess in the evaluation of primary aldosteronism

Indication and Technical Aspects of Adrenal Blood Sampling

Vascular Endothelial Growth Factor-A and Aldosterone

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