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. 2023 Jan;46(1):111-122.
doi: 10.1007/s40618-022-01889-1. Epub 2022 Aug 10.

Renin and electrolytes indicate the mineralocorticoid activity of fludrocortisone: a 6 year study in primary adrenal insufficiency

F Ceccato  1   2 , M Torchio  3   4 , I Tizianel  3   4 , M Peleg Falb  3 , M Barbot  3   4 , C Sabbadin  4 , C Betterle  3 , C Scaroni  3   4
Affiliations

Renin and electrolytes indicate the mineralocorticoid activity of fludrocortisone: a 6 year study in primary adrenal insufficiency

F Ceccato et al. J Endocrinol Invest. 2023 Jan.

Abstract

Context: Fludrocortisone (FC) is the mineralocorticoid (MC) replacement treatment for patients with primary adrenal insufficiency (PAI).

Objective: To explore the dose of FC treatment and its relationship with glucocorticoid therapy, sodium, potassium, renin and clinical parameters.

Setting: Monocentric cohort.

Patients: Data of 193 patients with PAI (130 autoimmune) were collected during baseline (T0), intermediate (T1) and last follow-up visit (T2, respectively, after a mean of 38 and 72 months).

Main outcome measure: Utility of endocrine and clinical parameters to titrate FC dose.

Results: FC dose (50-75 μg/daily) was stable in the follow-up in half patients. The MC activity of FC was dose-dependent: we observed a reduced but significant positive linear correlation between FC dose and sodium (r = 0.132) and negative linear correlation between FC and potassium (r = - 0.162) or renin (r = - 0.131, all p < 0.01). An overall reduction in the FC dose was observed at T2 in the group with longer follow-up (> 60 months, p < 0.05). Higher doses of FC were observed in patients with low-normal renin, especially in autoimmune PAI (86 vs 65 μg/daily, p < 0.05). On the contrary, reduced sodium and increased potassium levels were observed in patients with high renin at T2. The number of cardiovascular events (15 in the whole cohort) was similar in patients sorted by renin levels or FC dose.

Conclusions: Renin and electrolytes can indicate the MC activity of FC treatment: they should be routinely evaluated and used to titrate its dose that can be reduced in the long-term follow-up.

Keywords: Fludrocortisone; Mineralocorticoid treatment; Primary adrenal insufficiency; Renin.

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Conflict of interest statement

All authors declare that they have no conflicts of interest that might be perceived as influencing the impartiality of the reported research.

Figures

Fig. 1
Fig. 1
Distribution of hydrocortisone (HC, panel a) and fludrocortisone (FC, panel b) daily dose in the baseline (black bar), intermediate (white bar) and last visit (grey bar) in all patients with PAI (n = 193)
Fig. 2
Fig. 2
Mean daily dose of FC (black line) and HC equivalent (HC Eq, grey line) in the baseline, intermediate and last visit in patients with PAI and long-term follow up (panel a, 115 patients) and short-term follow-up (panel b, 78 patients)
Fig. 3
Fig. 3
Scatter plot indicating the linear correlation between FC dose and the respective level of sodium (panel a), potassium (panel b) and the ratio PRC/ULN or PRA/ULN (panel c) in all visits
Fig. 4
Fig. 4
Longitudinal analysis of electrolytes, renin and HC Eq in patients with PAI at baseline and last follow-up visit (from T0 to T2, mean follow-up 73 months), according to the modification of FC treatment
See this image and copyright information in PMC

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