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. 2019 Aug;65(2):399-407.
doi: 10.1007/s12020-019-01974-1. Epub 2019 Jun 8.

Plasma renin levels are associated with cardiac function in primary adrenal insufficiency

Peter Wolf  1 , Hannes Beiglböck  1 , Paul Fellinger  1 , Lorenz Pfleger  1   2 , Stefan Aschauer  3 , Alois Gessl  1 , Rodrig Marculescu  4 , Siegfried Trattnig  2 , Alexandra Kautzky-Willer  1 , Anton Luger  1 , Yvonne Winhofer  1 , Martin Krššák  1   2 , Michael Krebs  5
Affiliations

Plasma renin levels are associated with cardiac function in primary adrenal insufficiency

Peter Wolf et al. Endocrine. 2019 Aug.

Abstract

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 heart function and morphology.

Methods: Thirty two patients with primary AI were included in a cross-sectional case-control study. In total, 17 patients and 34 healthy controls (age: 48 ± 12 vs. 46 ± 18 years; BMI: 23 ± 3 vs. 24 ± 3 kg/m2) underwent magnetic resonance spectroscopy and imaging measurements to assess cardiac function, morphology, ectopic lipids, and visceral/subcutaneous fat mass. 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 with controls, ejection fraction 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 with >20 mg of hydrocortisone per day.

Conclusions: Higher renin concentrations are associated with more favorable cardiac function and morphology in patients with primary AI.

Keywords: Addison’s disease; Ectopic lipids; Glucocorticoid replacement therapy; Renin–angiotensin–aldosterone system.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Flowchart: recruitment process of all patients with available plasma renin concentrations of previous visits at the endocrine outpatients’ clinic. TTE transthoracic echocardiography, VAT visceral adipose tissue, SAT subcutaneous adipose tissue
Fig. 2
Fig. 2
Ejection fraction and left ventricular mass in patients with normal to slightly elevated (Median Renin Low; bright gray boxplot), elevated (Median Renin High; dark gray boxplot) plasma renin concentrations during the previous four routine clinical visits at the endocrinology outpatients clinic, and healthy controls (Controls; white boxplot); comparison between different groups was performed by using unpaired Student’s t test; *p < 0.05
See this image and copyright information in PMC

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