Health-Related Quality of Life and Mental Health in Primary Aldosteronism: A Systematic Review

Abstract

The aim of this review was to determine the impact of primary aldosteronism on health-related quality of life (HRQoL) and mental health. We performed a systematic literature search up to July 2017 in six electronic databases. First, we screened the articles derived from this search based on title and abstract. Second, the selected studies were systematically reviewed and checked for our predefined inclusion criteria. The search yielded 753 articles, of which 15 studies met our inclusion criteria. Untreated patients with primary aldosteronism showed an impaired physical and mental HRQoL as compared to the general population. Multiple domains of HRQoL were affected. This applied to patients with both an aldosterone-producing adenoma and bilateral adrenal hyperplasia. Adrenalectomy improves HRQoL. Conflicting results have been reported on the extent of this improvement, the improvement after initiation of medical treatment, and whether there is a difference in HRQoL after both treatments. Similarly, psychopathological symptoms of anxiety, demoralization, stress, depression and nervousness were more frequently reported in untreated patients with primary aldosteronism than in the general population and patients with hypertension. Also an impaired sleep quality has been reported. Improvement of these symptoms was observed after treatment with both adrenalectomy and mineralocorticoid receptor antagonists. This review shows that HRQoL is impaired and psychopathology is more frequently reported in patients with primary aldosteronism. This seems to be at least partly reversible after treatment but the extent of improvement remains unknown. To assess HRQoL in these patients more precisely a primary aldosteronism-specific HRQoL questionnaire is required.

Diagnosis and treatment of primary aldosteronism: practical clinical perspectives

“…Untreated patients with PA (APA and IHA) showed an impaired physical and mental QoL compared to the general population. Symptoms of anxiety, demoralization, stress, depression and nervousness were more frequently reported in untreated patients with PA than in the general population and in patients with hypertension . Adrenalectomy improved QoL and the symptoms of psychopathology.…”

Top‐down and bottom‐up control of stress‐coping

“…At a certain threshold, this may lead to a condition of HPA axis dysregulation and impaired behavioural adaptation, which can enhance susceptibility to stress-related neurodegeneration and mental disorders." 198 Antidepressants are known to induce MR synthesis, 199 and attempts to link aldosterone-MR biomarkers to treatment outcome in mental disorders are promising for hyperaldosteronism. 191 MR is the primordial receptor for glucocorticoid receptors (GRs) and progesterone receptors (PRs) which may explain its promiscuous nature in binding with high affinity to aldosterone, deoxycorticosterone, cortisol, corticosterone and progesterone.…”

Aldosterone-sensitive HSD2 neurons in mice

“…Over the past two decades, conflicting information has accumulated regarding which brain regions contain cells with Hsd11b2 mRNA, HSD2 immunoreactivity, 11-beta-dehydrogenase activity, or aldosterone-sensitivity (Jellinck et al, 1993; Sakai et al, 1996; Robson et al, 1998; Sakai et al, 2000; Zhang et al, 2006; Geerling and Loewy, 2007a; Naray-Fejes-Toth and Fejes-Toth, 2007; Geerling and Loewy, 2009; Askew et al, 2015; Haque et al, 2015). Resolving these conflicts will allow us to focus effort on the specific brain circuit(s) that sense aldosterone to promote sodium appetite or to cause anhedonic and dysphoric symptoms during hyperaldosteronism in experimental animals (Grippo et al, 2006; Morris et al, 2006; Hlavacova and Jezova, 2008; Hlavacova et al, 2012) and human patients (Malinow and Lion, 1979; Sonino et al, 2006; Sonino et al, 2011; Velema et al, 2017; Reincke, 2018). …”