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J Clin Endocrinol Metab. 2020 Jan 1;105(1). pii: dgz055. doi: 10.1210/clinem/dgz055.

Plasma Renin Measurements are Unrelated to Mineralocorticoid Replacement Dose in Patients With Primary Adrenal Insufficiency.

Author information

1
Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM) and NIHR Oxford Biomedical Research Centre, Churchill Hospital, University of Oxford, Oxford, UK.
2
Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy.
3
Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, UK.
4
Developmental Endocrinology Research Group, University of Glasgow, UK.
5
Department of Medical and Surgical Sciences, Paediatric Unit, S.Orsola-Malpighi University Hospital, Bologna, Italy.
6
Division of Endocrinology, Department of System Medicine, Section of Reproductive Endocrinology, Tor Vergata University of Rome, Fatebenefratelli Hospital San Giovanni Calibita, Rome, Italy.
7
Saglik Bilimleri University, Zeynep Kamil Women and Children Hospital, Paediatric Endocrinology Clinic, Istanbul, Turkey.
8
Marmara University, Department of Paediatric Endocrinology and Diabetes, Pendik, Istanbul, Turkey.
9
Istanbul Faculty of Medicine, Department of Paediatrics, Paediatric Endocrinology Unit, Istanbul University, Çapa, Istanbul, Turkey.
10
Department of Endocrinology, Christie Hospital NHS Foundation Trust, Manchester, University Of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
11
Department of Paediatrics, Klinikum Wels-Grieskirchen, Wels, Austria; Department of Paediatrics, Technical University München, Munich, Germany.
12
The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.
13
Sackler School of Medicine, Tel Aviv University, Israel.
14
Unidade De Endocrinologia Do Desenvolvimento, Laboratório De Hormônios E Genética Molecular/Lim42, Hospital Das Clinicas Hcfmusp, Faculdade De Medicina, Universidade De Sao Paulo, Sao Paulo, Brazil.
15
Clinic Of Paediatric Endocrinology - UMHAT 'Sv. Marina', Medical University of Varna, Varna, Bulgaria.
16
Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, UK.
17
The University of Sheffield, Sheffield, UK.
18
Birmingham Women's & Children's Hospital, Department for Endocrinology & Diabetes, Birmingham, UK.
19
NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK.

Abstract

CONTEXT:

No consensus exists for optimization of mineralocorticoid therapy in patients with primary adrenal insufficiency.

OBJECTIVE:

To explore the relationship between mineralocorticoid (MC) replacement dose, plasma renin concentration (PRC), and clinically important variables to determine which are most helpful in guiding MC dose titration in primary adrenal insufficiency.

DESIGN:

Observational, retrospective, longitudinal analysis.

PATIENTS:

A total of 280 patients (with 984 clinical visits and plasma renin measurements) with primary adrenal insufficiency were recruited from local databases and the international congenital adrenal hyperplasia (CAH) registry (www.i-cah.org). Thirty-seven patients were excluded from the final analysis due to incomplete assessment. Data from 204 patients with salt-wasting CAH (149 adults and 55 children) and 39 adult patients with Addison disease (AD) were analysed.

MAIN OUTCOME MEASURES:

PRC, electrolytes, blood pressure (BP), and anthropometric parameters were used to predict their utility in optimizing MC replacement dose.

RESULTS:

PRC was low, normal, or high in 19%, 36%, and 44% of patients, respectively, with wide variability in MC dose and PRC. Univariate analysis demonstrated a direct positive relationship between MC dose and PRC in adults and children. There was no relationship between MC dose and BP in adults, while BP increased with increasing MC dose in children. Using multiple regression modeling, sodium was the only measurement that predicted PRC in adults. Longitudinally, the change in MC dose was able to predict potassium, but not BP or PRC.

CONCLUSIONS:

The relationship between MC dose and PRC is complex and this may reflect variability in sampling with respect to posture, timing of last MC dose, adherence, and concomitant medications. Our data suggest that MC titration should not primarily be based only on PRC normalization, but also on clinical parameters such as BP and electrolyte concentration.

PMID:
31613957
DOI:
10.1210/clinem/dgz055

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