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Schneider H, Brüdgam D, Nowotny HF, Schmidmaier R, Reincke M, Adolf C. Moderate salt restriction in primary aldosteronism improves bone metabolism through attenuation of urinary calcium and phosphate losses. Eur J Endocrinol 2024; 190:K47-K52. [PMID: 38557596 DOI: 10.1093/ejendo/lvae020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 01/09/2024] [Accepted: 02/05/2024] [Indexed: 04/04/2024]
Abstract
Accumulating evidence links osteoporosis and dietary salt consumption. Primary aldosteronism (PA) is a model disease with increased dietary salt intake and constitutes an independent risk factor for osteoporosis. We, thus, assessed whether a short-term moderate reduction in salt intake in PA results in detectable osteoanabolic effects. Forty-one patients with PA on stable mineralocorticoid receptor antagonist therapy were subjected to a 12-week salt restriction. Serum and urinary electrolytes, markers of bone turnover, and a 15 steroids plasma profile were registered. After 12 weeks, urinary calcium and phosphate decreased, while plasma testosterone, serum phosphate, and bone alkaline phosphatase (BAP) all increased significantly. Longitudinal changes in BAP were independently correlated with changes in serum phosphate, parathyroid hormone, and urinary calcium in multivariate analysis. Salt restriction in PA limits urinary calcium and phosphate losses and may confer favorable osteoanabolic effects. Our findings suggest that salt restriction should be considered in patients with PA to improve bone health.
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Affiliation(s)
- Holger Schneider
- Department of Medicine IV, LMU University Hospital, LMU Munich, Munich, Germany
| | - Denise Brüdgam
- Department of Medicine IV, LMU University Hospital, LMU Munich, Munich, Germany
| | - Hanna F Nowotny
- Department of Medicine IV, LMU University Hospital, LMU Munich, Munich, Germany
| | - Ralf Schmidmaier
- Department of Medicine IV, LMU University Hospital, LMU Munich, Munich, Germany
| | - Martin Reincke
- Department of Medicine IV, LMU University Hospital, LMU Munich, Munich, Germany
| | - Christian Adolf
- Department of Medicine IV, LMU University Hospital, LMU Munich, Munich, Germany
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Mulatero P, Scholl UI, Fardella CE, Charmandari E, Januszewicz A, Reincke M, Gomez-Sanchez CE, Stowasser M, Dekkers OM. Familial hyperaldosteronism: an European Reference Network on Rare Endocrine Conditions clinical practice guideline. Eur J Endocrinol 2024; 190:G1-G14. [PMID: 38571460 DOI: 10.1093/ejendo/lvae041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 03/15/2024] [Indexed: 04/05/2024]
Abstract
We describe herein the European Reference Network on Rare Endocrine Conditions clinical practice guideline on diagnosis and management of familial forms of hyperaldosteronism. The guideline panel consisted of 10 experts in primary aldosteronism, endocrine hypertension, paediatric endocrinology, and cardiology as well as a methodologist. A systematic literature search was conducted, and because of the rarity of the condition, most recommendations were based on expert opinion and small patient series. The guideline includes a brief description of the genetics and molecular pathophysiology associated with each condition, the patients to be screened, and how to screen. Diagnostic and treatment approaches for patients with genetically determined diagnosis are presented. The recommendations apply to patients with genetically proven familial hyperaldosteronism and not to families with more than one case of primary aldosteronism without demonstration of a responsible pathogenic variant.
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Affiliation(s)
- Paolo Mulatero
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, 10126 Torino, Italy
| | - Ute I Scholl
- Center of Functional Genomics, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, 10115 Berlin, Germany
| | - Carlos E Fardella
- Department of Endocrinology, School of Medicine, Centro Traslacional de Endocrinología Universidad Católica (CETREN-UC), Pontificia Universidad Católica de Chile, 8330033 Santiago, Chile
| | - Evangelia Charmandari
- Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, Athens 11527, Greece
- Division of Endocrinology and Metabolism, Center for Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens 11527, Greece
| | - Andrzej Januszewicz
- Department of Hypertension, National Institute of Cardiology, 02-628 Warsaw, Poland
| | - Martin Reincke
- Department of Medicine 4, LMU University Hospital, LMU Munich, Munich D-80336, Germany
| | - Celso E Gomez-Sanchez
- Research Service, G. V. (Sonny) Montgomery VA Medical Center, Jackson, MS 39216, United States
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, 39216 MS, United States
| | - Michael Stowasser
- Endocrine Hypertension Research Centre, University of Queensland Frazer Institute, Greenslopes and Princess Alexandra Hospitals, Brisbane, 4102 Queensland, Australia
| | - Olaf M Dekkers
- Departments of Clinical Epidemiology and Internal Medicine, Leiden University Medical Centre, 2311 Leiden, The Netherlands
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Buffolo F, Pecori A, Reincke M, Outland M, Veglio F, Schwarzlmüller P, Bidlingmaier M, Kunz S, Stremmel C, Mengozzi G, Priolo G, Mulatero P, Adolf C, Monticone S. Long-Term Follow-Up of Patients With Elevated Aldosterone-to-Renin Ratio but Negative Confirmatory Test: The Progression of Primary Aldosteronism Phenotypes. Hypertension 2024; 81:340-347. [PMID: 38084587 DOI: 10.1161/hypertensionaha.123.21983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/16/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND About 10% of patients with arterial hypertension have a positive screening test for primary aldosteronism (PA) and 50% to 70% of them have a negative confirmatory test: the appropriate follow-up of these patients is currently unknown. We investigated the incidence of PA in patients with previous negative confirmatory testing, after at least a 2-year follow-up. METHODS One hundred eighty-four patients with a previously elevated aldosterone-to-renin ratio followed by a negative confirmatory test were recruited in 2 hypertension centers (Torino and Munich). We repeated the screening test for PA and, if positive, the confirmatory test (seated saline infusion test or captopril challenge test). Primary end point of the study was the incidence of newly diagnosed overt PA, as defined by a positive confirmatory test. RESULTS After a mean follow-up of 5 years, 20% of patients developed overt PA. When subtype diagnosis was offered systematically, one-third of patients displayed unilateral PA. Patients who developed PA showed worsening of blood pressure control and a higher rate of cardiac organ damage, despite similar implementation of antihypertensive therapy, compared with patients without PA. A mild progression of autonomous aldosterone secretion was evident even in patients without confirmed PA but with relatively stable control of blood pressure levels over time. CONCLUSIONS About one-fifth of patients with a negative confirmatory test develop overt PA over time. A clinical follow-up of patients with a negative confirmatory test is advisable, along with the repetition of PA investigation, primarily in patients with worsening of blood pressure control.
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Affiliation(s)
- Fabrizio Buffolo
- Division of Internal Medicine 4 and Hypertension Unit, Department of Medical Sciences (F.B., A.P., F.V., P.M., S.M.), University of Torino, Italy
| | - Alessio Pecori
- Division of Internal Medicine 4 and Hypertension Unit, Department of Medical Sciences (F.B., A.P., F.V., P.M., S.M.), University of Torino, Italy
| | - Martin Reincke
- Medizinische Klinik und Poliklinik IV, Department of Medicine IV (M.R., M.O., P.S., M.B., S.K., C.A.), Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Merve Outland
- Medizinische Klinik und Poliklinik IV, Department of Medicine IV (M.R., M.O., P.S., M.B., S.K., C.A.), Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Franco Veglio
- Division of Internal Medicine 4 and Hypertension Unit, Department of Medical Sciences (F.B., A.P., F.V., P.M., S.M.), University of Torino, Italy
| | - Paul Schwarzlmüller
- Medizinische Klinik und Poliklinik IV, Department of Medicine IV (M.R., M.O., P.S., M.B., S.K., C.A.), Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Martin Bidlingmaier
- Medizinische Klinik und Poliklinik IV, Department of Medicine IV (M.R., M.O., P.S., M.B., S.K., C.A.), Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Sonja Kunz
- Medizinische Klinik und Poliklinik IV, Department of Medicine IV (M.R., M.O., P.S., M.B., S.K., C.A.), Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Christopher Stremmel
- Medizinische Klinik und Poliklinik I (C.S.), Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Giulio Mengozzi
- Department of Laboratory Medicine (G.M., G.P.), University of Torino, Italy
| | - Gabriella Priolo
- Department of Laboratory Medicine (G.M., G.P.), University of Torino, Italy
| | - Paolo Mulatero
- Division of Internal Medicine 4 and Hypertension Unit, Department of Medical Sciences (F.B., A.P., F.V., P.M., S.M.), University of Torino, Italy
| | - Christian Adolf
- Medizinische Klinik und Poliklinik IV, Department of Medicine IV (M.R., M.O., P.S., M.B., S.K., C.A.), Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Silvia Monticone
- Division of Internal Medicine 4 and Hypertension Unit, Department of Medical Sciences (F.B., A.P., F.V., P.M., S.M.), University of Torino, Italy
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Sun F, Zhang JY, Zhao LP, Jin Q, Jin C, Wang QX, Xu JT, Yin MJ. Age differences in the impact of dietary salt on metabolism, blood pressure and cognitive function in male rats. Food Funct 2024; 15:689-703. [PMID: 38108607 DOI: 10.1039/d3fo04211a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
The influence of salt consumption on physiological processes, especially blood pressure (BP), metabolism, and cognition, remains a topical concern. While guidelines endorse reduced salt diets, there are gaps in understanding the age-specific implications and challenges in adherence. The present study delved into the differential effects of salt intake on young adult and aged male rats over a 12-week period, using control, low-, and high-salt diets. Key metrics, such as BP, cognition, and general parameters, were monitored. Our findings revealed significant age-dependent effects of salt intake on survival rates, body weight, blood sodium, blood glucose, blood lipids, BP, heart rates, and cognition. Notably, young adult rats did not show significant sodium level changes on a high-salt diet, whereas aged rats experienced increased sodium levels even on a normal salt diet. Blood glucose levels decreased significantly in aged rats on a high-salt diet but remained stable in young adults. Aged rats had the highest survival rates on low-salt diets. Low-salt diets led to reduced BP in both age groups, more significantly in young adults. Young adult rats displayed increased BP variability on both high- and low-salt diets, while a decrease in BP variability was exclusive to aged rats on a low-salt diet. There were significant differences across age groups in short-term memory, but not in long-term memory. The study provides a nuanced understanding of the age-dependent physiological effects of salt intake, suggesting the necessity of age-specific guidelines for public health.
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Affiliation(s)
- Fen Sun
- College of Basic Medicine, Hangzhou Normal University, Hangzhou, Zhejiang, China.
| | - Jin-Yang Zhang
- College of Basic Medicine, Hangzhou Normal University, Hangzhou, Zhejiang, China.
| | - Lu-Ping Zhao
- College of Basic Medicine, Hangzhou Normal University, Hangzhou, Zhejiang, China.
| | - Qi Jin
- College of Basic Medicine, Hangzhou Normal University, Hangzhou, Zhejiang, China.
| | - Chao Jin
- College of Basic Medicine, Hangzhou Normal University, Hangzhou, Zhejiang, China.
| | - Qiu-Xiang Wang
- College of Basic Medicine, Hangzhou Normal University, Hangzhou, Zhejiang, China.
| | - Jun-Tao Xu
- College of Basic Medicine, Hangzhou Normal University, Hangzhou, Zhejiang, China.
| | - Meng-Jia Yin
- College of Basic Medicine, Hangzhou Normal University, Hangzhou, Zhejiang, China.
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Chen L, Adolf C, Reincke M, Schneider H. Salt and Aldosterone - Reciprocal and Combined Effects in Preclinical Models and Humans. Horm Metab Res 2024; 56:99-106. [PMID: 37683690 PMCID: PMC10781566 DOI: 10.1055/a-2172-7228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/03/2023] [Indexed: 09/10/2023]
Abstract
Primary aldosteronism is an endocrine disorder caused by excessive production of aldosterone by the adrenal glands, and is recognized as the most important cause of endocrine hypertension. With specific therapy, this type of hypertension is potentially curable. In the general population, high salt intake increases the risk for cardiovascular diseases like stroke. In populations with aldosterone excess, observational and experimental data suggest that aldosterone-induced organ damage requires a combination of high dietary salt intake and high plasma aldosterone, i.e., plasma aldosterone levels inappropriately high for salt status. Therefore, understanding the relationship between plasma aldosterone levels and dietary salt intake and the nature of their combined effects is crucial for developing effective prevention and treatment strategies. In this review, we present an update on findings about primary aldosteronism and salt intake and the underlying mechanisms governing their interaction.
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Affiliation(s)
- Li Chen
- Medizinische Klinik und Poliklinik IV, LMU Klinikum, LMU
München, München, Germany
| | - Christian Adolf
- Medizinische Klinik und Poliklinik IV, LMU Klinikum, LMU
München, München, Germany
| | - Martin Reincke
- Medizinische Klinik und Poliklinik IV, LMU Klinikum, LMU
München, München, Germany
| | - Holger Schneider
- Medizinische Klinik und Poliklinik IV, LMU Klinikum, LMU
München, München, Germany
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