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Patients with primary aldosteronism respond to unilateral adrenalectomy with long-term reduction in salt intake


Adolf, Christian; Heinrich, Daniel A; Holler, Finn; Lechner, Benjamin; Nirschl, Nina; Sturm, Lisa; Görge, Veronika; Riester, Anna; Williams, Tracy A; Treitl, Marcus; Ladurner, Roland; Beuschlein, Felix; Reincke, Martin (2020). Patients with primary aldosteronism respond to unilateral adrenalectomy with long-term reduction in salt intake. Journal of Clinical Endocrinology & Metabolism, 105(3):x-x.

Abstract

CONTEXT
High dietary salt intake is known to aggravate arterial hypertension. This effect could be of particular relevance in the setting of primary aldosteronism (PA), which is associated with cardiovascular damage independent of blood pressure levels. The aim of this study was to determine the impact of therapy on salt intake in PA patients.
PATIENTS AND METHODS
148 consecutive PA patients (66 with unilateral and 82 with bilateral PA) from the database of the German Conn's Registry were included. Salt intake was quantified by 24-hour urinary sodium excretion before and after initiation of PA treatment.
STUDY DESIGN
Observational longitudinal cohort study.
SETTING Tertiary care hospital.
RESULTS
At baseline, unilateral PA patients had a significantly higher urinary sodium excretion than patients with bilateral disease (205 vs. 178 mmol/d, p= 0.047). Higher urinary sodium excretion correlated with an increased cardiovascular risk profile including proteinuria, impaired lipid and glucose metabolism and was associated with higher daily doses of antihypertensive drugs to achieve blood pressure control. In unilateral disease, urinary sodium excretion dropped spontaneously to 176 mmol/d (p= 0.012) one year after unilateral adrenalectomy and remained low at three year of follow-up (174 mmol/d). In contrast, treatment with mineralocorticoid receptor antagonists (MRA) in bilateral PA patients was not associated with a significant change in urinary sodium excretion at follow-up (179 mmol/d vs. 183 mmol/d).
CONCLUSION
PA patients consuming a high salt diet, estimated based on urinary sodium excretion, respond to adrenalectomy with a significant reduction of salt intake, in contrast to MRA treatment.

Abstract

CONTEXT
High dietary salt intake is known to aggravate arterial hypertension. This effect could be of particular relevance in the setting of primary aldosteronism (PA), which is associated with cardiovascular damage independent of blood pressure levels. The aim of this study was to determine the impact of therapy on salt intake in PA patients.
PATIENTS AND METHODS
148 consecutive PA patients (66 with unilateral and 82 with bilateral PA) from the database of the German Conn's Registry were included. Salt intake was quantified by 24-hour urinary sodium excretion before and after initiation of PA treatment.
STUDY DESIGN
Observational longitudinal cohort study.
SETTING Tertiary care hospital.
RESULTS
At baseline, unilateral PA patients had a significantly higher urinary sodium excretion than patients with bilateral disease (205 vs. 178 mmol/d, p= 0.047). Higher urinary sodium excretion correlated with an increased cardiovascular risk profile including proteinuria, impaired lipid and glucose metabolism and was associated with higher daily doses of antihypertensive drugs to achieve blood pressure control. In unilateral disease, urinary sodium excretion dropped spontaneously to 176 mmol/d (p= 0.012) one year after unilateral adrenalectomy and remained low at three year of follow-up (174 mmol/d). In contrast, treatment with mineralocorticoid receptor antagonists (MRA) in bilateral PA patients was not associated with a significant change in urinary sodium excretion at follow-up (179 mmol/d vs. 183 mmol/d).
CONCLUSION
PA patients consuming a high salt diet, estimated based on urinary sodium excretion, respond to adrenalectomy with a significant reduction of salt intake, in contrast to MRA treatment.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Endocrinology and Diabetology
Dewey Decimal Classification:610 Medicine & health
Scopus Subject Areas:Health Sciences > Endocrinology, Diabetes and Metabolism
Life Sciences > Biochemistry
Life Sciences > Endocrinology
Life Sciences > Clinical Biochemistry
Health Sciences > Biochemistry (medical)
Language:English
Date:1 March 2020
Deposited On:17 Dec 2019 13:24
Last Modified:01 Dec 2020 13:13
Publisher:Oxford University Press
ISSN:0021-972X
OA Status:Hybrid
Free access at:PubMed ID. An embargo period may apply.
Publisher DOI:https://doi.org/10.1210/clinem/dgz051
PubMed ID:31702016

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