Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU München, Munich, Germany.
Medizinische Klinik und Poliklinik I, Klinikum der Universität München, LMU München, Munich, Germany.
J Clin Endocrinol Metab. 2018 Dec 1;103(12):4543-4552. doi: 10.1210/jc.2018-00617.
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.
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.
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.
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.
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.
原发性醛固酮增多症（PA）是内分泌性高血压最常见的形式。醛固酮增多症和皮质醇增多症均会导致左心室肥厚（LVH）过度，与匹配的原发性高血压患者相比。在最近的研究中，报道了 PA 患者中皮质醇和醛固酮频繁共分泌的情况。
我们旨在研究皮质醇共分泌对 PA 患者 LVH 的影响。我们通过气相色谱-质谱联用测定了皮质醇和醛固酮的 24 小时排泄量，并在开始治疗 PA 后 1 年，最初和 1 年时使用超声心动图评估心脏重构。
我们纳入了德国康恩氏登记处慕尼黑中心的 73 名患者：45 名单侧醛固酮产生腺瘤患者和 28 名双侧肾上腺增生患者。
在诊断时，85%的 PA 患者根据左心室质量指数（LVMI）显示 LVH[中位数 62.4 g/m2.7]。LVMI 与总糖皮质激素排泄呈正相关（r2 = 0.076，P = 0.018），与四氢醛固酮排泄呈正相关（r2 = 0.070，P = 0.024）。肾上腺切除术导致醛固酮产生腺瘤患者的 LVMI 显著降低（P < 0.001），而双侧肾上腺增生患者的盐皮质激素受体拮抗剂治疗降低 LVMI 的程度较小（P = 0.024）。在多变量分析中，LVMI 的降低与总糖皮质激素排泄和 24 小时收缩压呈正相关，但与四氢醛固酮排泄无关。
皮质醇过多似乎对 PA 患者的心脏重构有额外影响。通过肾上腺切除术或盐皮质激素受体拮抗剂治疗 PA 可改善 LVMI。在总糖皮质激素排泄量高的患者中，这种效果最为明显。
