Synergistic interplay between cortisol and aldosterone: unveiling mechanisms of vascular calcification in hyperaldosteronism

Abstract

The synergistic interplay between cortisol and aldosterone is critical for maintaining homeostasis, particularly in blood pressure regulation, fluid balance, and stress response. Cortisol, a glucocorticoid, and aldosterone, a mineralocorticoid, often act in tandem to regulate sodium retention and blood volume. Dysregulation of these hormones, as seen in hyperaldosteronism or Cushing's syndrome, contributes to hypertension and metabolic imbalances. The synergistic effects of autonomous cortisol secretion (ACS) and aldosterone on vascular calcification, focusing on patients with primary aldosteronism (PA). Update findings reveal that cortisol and aldosterone synergistically promote vascular calcification via mineralocorticoid receptor (MR)-dependent pathways, a mechanism effectively attenuated by MR antagonism. Despite a relatively small ACS subgroup, the study highlights critical insights into the cardiovascular risks associated with ACS and PA, emphasizing the need for larger, multicenter studies and long-term outcome data. We might underscore the potential of MR antagonists in mitigating cardiovascular risks and pave the way for broader applications to other conditions involving cortisol dysregulation, such as adrenal incidentalomas and subclinical Cushing's syndrome.

Keywords: Aldosterone; Cortisol; Cushing; Hyperaldosteronism; Vascular calcification.