Mild Adrenal Steroidogenic Defects and ACTH-Dependent Aldosterone Secretion in High Blood Pressure: Preliminary Evidence

Abstract

Introduction. Adrenal glands play a major role in the control of blood pressure and mild defects of steroidogenesis and/or inappropriate control of mineralocorticoid production have been reported in high blood pressure (HBP). Patients and Methods. We used a specific protocol for the evaluation of 100 consecutive patients with inappropriate or recent onset HBP. Specific methods were used to confirm HBP and to diagnose secondary forms of HBP. In addition we tested adrenal steroidogenesis with the common cosyntropin test, modified to include the simultaneous measurement of renin and aldosterone besides 17-hydroxyprogesterone (17OHP) and 11-deoxycortisol (S). Results. Secondary forms of HBP were diagnosed in 32 patients, including 14 patients with primary hyperaldosteronism (PA) (14%) and 10 patients with pheochromocytoma (10%). Mild defects of the 21-hydroxylase (21OHD) and 11-hydroxylase (11OHD) enzymes were common (42%). ACTH-dependent aldosterone secretion was found in most patients (54%) and characteristically in those with mild defects of adrenal steroidogenesis (>60%), PA (>75%), and otherwise in patients with apparent essential HBP (EHBP) (32%). Discussion. Mild defects of adrenal steroidogenesis are common in patients with HBP, occurring in almost half of the patients. In those patients as well as in patients with apparent EHBP, aldosterone secretion is commonly dependent on ACTH.

A retrospective pilot study examining the use of Acthar gel in sarcoidosis patients

“…In the current study, major drug toxicities included peripheral edema and agitation, similar to previous case reports [6]. Peripheral edema may be related to mineralocorticoid release due to Acthar gel stimulation [24]. In some patients, symptom improvement occurred with aldosterone blockade with spironolactone.…”

Autonomous Aldosterone Secretion as a Subclinical Form of Primary Aldosteronism: Pathogenesis and Clinical Significance

“…Crucially, MRA monotherapy normalized BP in hypersecreting but not in remaining HT patients [54]. Martins et al also recorded excessive Ald response to cosyntropin: 54 % of selected 100 patients had high BP, which included 79 % of PA and 32 % of primary HT patients [53].…”

“…In the above-mentioned study by Cao and colleagues, adrenal tissue of AI patients with high ARR exhibited increased ACTH receptor mRNA expression [26]. Corticotropin was demonstrated as an important aldosterone secretagogue in IHA in 1976, and, later confirmed among a high percentage of hypertensives [51][52][53][54].…”