Plasma renin measurements are unrelated to mineralocorticoid replacement dose in patients with primary adrenal insufficiency.

Pofi, Riccardo and Prete, Alessandro and Thornton-Jones, Vivien and Bryce, Jillian and Ali, Salma R and Faisal Ahmed, S and Balsamo, Antonio and Baronio, Federico and Cannuccia, Amalia and Guven, Ayla and Guran, Tulay and Darendeliler, Feyza and Higham, Claire and Bonfig, Walter and de Vries, Liat and Bachega, Tania A S S and Miranda, Mirela C and Mendonca, Berenice B and Iotova, Violeta and Korbonits, Màrta and Krone, Nils P and Krone, Ruth and Lenzi, Andrea and Arlt, Wiebke and Ross, Richard J and Isidori, Andrea M and Tomlinson, Jeremy W (2019) Plasma renin measurements are unrelated to mineralocorticoid replacement dose in patients with primary adrenal insufficiency. The Journal of clinical endocrinology and metabolism. ISSN 1945-7197.

Full text not available from this repository.
Official URL: https://academic.oup.com/jcem/advance-article-abst...

Abstract

CONTEXT

No consensus exists for optimization of mineralocorticoid therapy in patients with primary adrenal insufficiency.

OBJECTIVE

To explore the relationship between mineralocorticoid replacement dose, plasma renin concentration (PRC) and clinically important variables to determine which are most helpful in guiding mineralocorticoid dose titration in primary adrenal insufficiency.

DESIGN

Observational, retrospective, longitudinal analysis.

PATIENTS

280 patients (with 984 clinical visits and plasma renin measurements) with primary adrenal insufficiency recruited from local databases and the international congenital adrenal hyperplasia (CAH) registry (www.i-cah.org). Thirty-seven patients were excluded from the final analysis due to incomplete assessment. Data from 204 patients with salt-wasting CAH (SW-CAH) (149 adults and 55 children) and 39 adult patients with Addison's disease (AD) were analysed.

MAIN OUTCOME MEASURES

PRC, electrolytes, blood pressure (BP) and anthropometric parameters were used to predict their utility in optimizing MC replacement dose.

RESULTS

PRC was low, normal or high in 19%, 36% and 44% of patients, respectively, with wide variability in mineralocorticoid dose and PRC. Univariate analysis demonstrated a direct positive relationship between mineralocorticoid dose and PRC in adults and children. There was no relationship between mineralocorticoid dose and BP in adults, while BP increased with increasing mineralocorticoid dose in children. Using multiple regression modelling, sodium was the only measurement that predicted PRC in adults. Longitudinally, the change in mineralocorticoid dose was able to predict potassium, but not BP or PRC.

CONCLUSIONS

The relationship between mineralocorticoid dose and PRC is complex and this may reflect variability in sampling with respect to posture, timing of last mineralocorticoid dose, adherence and concomitant medications. Our data suggests that mineralocorticoid titration should not primarily be based only on PRC normalization, but also on clinical parameters as BP and electrolyte concentration.

Item Type: Article
Subjects: WK Endocrine system. Endocrinology
Divisions: Clinical Support
Related URLs:
Depositing User: Mrs Suganthi Vijayaganesh
Date Deposited: 23 Oct 2019 14:06
Last Modified: 23 Oct 2019 14:06
URI: http://www.repository.uhblibrary.co.uk/id/eprint/2515

Actions (login required)

View Item View Item