Quality of life in patients with primary aldosteronism: Gender differences in untreated and long-term treated patients and associations with treatment and aldosterone

Künzel, Heike; Apostolopoulou, Konstantina; Pallauf, Anna; Gerum, S.; Merkle, Katrin; Schulz, Sebastian; Fischer, Evelyn; Brand, Volker; Bidlingmaier, Martin; Endres, Stephan; Beuschlein, Felix; Reincke, Martín

doi:10.1016/j.jpsychires.2012.08.025

Cited by 51 publications

(43 citation statements)

References 25 publications

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“…As expected, treatment with MRAs has a negative impact on the quality of life as has been shown in several studies and this pertains to both mental and physical well-being (Kunzel et al, 2012). This is particularly apparent in female patients.…”

Section: Accepted Manuscriptsupporting

confidence: 75%

Pharmacological treatment of aldosterone excess

Deinum

Riksen

Lenders

2015

Pharmacology & Therapeutics

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Section: Accepted Manuscriptsupporting

confidence: 75%

Pharmacological treatment of aldosterone excess

Deinum

Riksen

Lenders

2015

Pharmacology & Therapeutics

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“…Treatment of PA patients with MR antagonists benefits their cardiovascular and electrolyte parameters, yet does not ameliorate cognitive scores, while removal of an aldosterone producing adenoma and normalization of aldosterone levels significantly improves both systemic and cognitive function (7, 255). As levels of aldosterone in these patients are not high enough to compete with cortisol for MR binding in nonaldosterone target tissues, these results suggest a deleterious role for excessive aldosterone activity through a non-MR-mediated mechanism.…”

Section: Mammalian Adrenocorticosteroids and Their Receptorsmentioning

confidence: 99%

The Multifaceted Mineralocorticoid Receptor

Gómez-Sánchez

2014

Comprehensive Physiology

274

224

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The primary adrenal cortical steroid hormones, aldosterone, and the glucocorticoids cortisol and corticosterone, act through the structurally similar mineralocorticoid (MR) and glucocorticoid receptors (GRs). Aldosterone is crucial for fluid, electrolyte, and hemodynamic homeostasis and tissue repair; the significantly more abundant glucocorticoids are indispensable for energy homeostasis, appropriate responses to stress, and limiting inflammation. Steroid receptors initiate gene transcription for proteins that effect their actions as well as rapid non-genomic effects through classical cell signaling pathways. GR and MR are expressed in many tissues types, often in the same cells, where they interact at molecular and functional levels, at times in synergy, others in opposition. Thus the appropriate balance of MR and GR activation is crucial for homeostasis. MR has the same binding affinity for aldosterone, cortisol, and corticosterone. Glucocorticoids activate MR in most tissues at basal levels and GR at stress levels. Inactivation of cortisol and corticosterone by 11β-HSD2 allows aldosterone to activate MR within aldosterone target cells and limits activation of the GR. Under most conditions, 11β-HSD1 acts as a reductase and activates cortisol/corticosterone, amplifying circulating levels. 11β-HSD1 and MR antagonists mitigate inappropriate activation of MR under conditions of oxidative stress that contributes to the pathophysiology of the cardiometabolic syndrome; however, MR antagonists decrease normal MR/GR functional interactions, a particular concern for neurons mediating cognition, memory, and affect.

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“…Impaired QOL in physical was reported by men and women with primary aldosteronism but more frequently reported in females, with untreated patients having the lowest QOL scores A randomized controlled trial comparing CT scanning to adrenal vein sampling to localize pathology and direct management found no difference in QOL between these groups . In patients undergoing unilateral adrenalectomy, improvement in blood pressure and biochemical parameters at 3 months were accompanied by an improvement in QOL .…”

Section: Resultsmentioning

confidence: 99%

Quality of life in patients with adrenal disease: A systematic review

Druce

2018

Clinical Endocrinology

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We present the first systematic review of QOL in adrenal disease. Quality of life is reduced in patients with adrenal disease, irrespective of adrenal hyperfunction or hypofunction. Quality of life improved with therapy but was not completely reversed despite biochemical remission. Authors should adhere to consistent reporting practices which are interpretable by clinicians. Further research is required to explain the mechanisms driving impaired QOL and value of QOL evaluations in the clinical context.

show abstract

Quality of life in patients with primary aldosteronism: Gender differences in untreated and long-term treated patients and associations with treatment and aldosterone

Cited by 51 publications

References 25 publications

Pharmacological treatment of aldosterone excess

Pharmacological treatment of aldosterone excess

The Multifaceted Mineralocorticoid Receptor

Quality of life in patients with adrenal disease: A systematic review

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