Measurement Of Aldosterone Research Articles

Effect of Moxonidine on the Aldosterone/Renin Ratio in Healthy Male Volunteers.

The most popular screening test for primary aldosteronism is the plasma aldosterone/renin ratio (ARR). Medications, dietary sodium, posture, and time of day all affect renin and aldosterone levels and can result in false-negative or false-positive ARRs if not controlled. Most antihypertensive medications affect the ARR and can interfere with interpretation of results. To our knowledge, no study has been undertaken to evaluate the effects of moxonidine on the ARR. Normotensive, nonmedicated male volunteers (n = 20) underwent measurement (seated, midmorning) of plasma aldosterone (by high-performance liquid chromatography-tandem mass spectrometry), direct renin concentration (DRC), plasma renin activity (PRA), cortisol, electrolytes and creatinine; and urinary aldosterone, cortisol, electrolytes and creatinine at baseline and after 1 week of moxonidine at 0.2 mg/d and a further 5 weeks at 0.4 mg/d. Compared with baseline, despite the expected significant falls in both systolic and diastolic blood pressure, levels of plasma aldosterone [median, 134 (range, 90 to 535) pmol/L], DRC [20 (10 to 37) mU/L], PRA [2.2 (1.0-3.8) ng/mL/h], and ARR using either DRC [8.0 (4.4 to 14.4)] or PRA [73 (36 to 218)] were not significantly changed after either 1 [135 (98-550) pmol/L, 20 (11-35) mU/L, 2.0 (1.2-4.1) ng/mL/h, 8.8 (4.2 to 15.9), and 73 (32-194), respectively] or 6 weeks [130 (90-500) pmol/L, 22 (8 to 40) mU/L, 2.1 (1.0 to 3.2) ng/mL/h, 7.7 (4.3 to 22.4), and 84 (32 to 192), respectively] of moxonidine. There were no changes in any urinary measurements. Moxonidine was associated with no significant change in the ARR and may therefore be a good option for maintaining control of hypertension when screening for primary aldosteronism.

322 - Ten minutes rapid measurement of aldosterone and active renin concentration may change the diagnosis and treatment of primary aldosteronism

322 - Ten minutes rapid measurement of aldosterone and active renin concentration may change the diagnosis and treatment of primary aldosteronism

New Advances in the Diagnostic Workup of Primary Aldosteronism.

Primary aldosteronism is an important and common cause of hypertension that carries a high burden of morbidity. Outcomes, however, are excellent if diagnosed and treated appropriately. The diagnostic workup for primary aldosteronism is complex and comprises three steps: (1) screening, (2) confirmatory testing, and (3) subtype differentiation. In this review, we discuss recent advances in the diagnostic workup for primary aldosteronism. The development of accurate mass spectroscopy–based assays for measuring aldosterone will lead to improved confidence in all diagnostic aspects involving measurement of aldosterone, and accurate measurement of angiotensin II may soon advance us beyond the measurement of renin. We now have a greater understanding of hormonal influences on the aldosterone/renin ratio, which are particularly important when screening premenopausal women or those taking estrogen-containing preparations. Confirmatory testing is important, but there are limitations to the commonly used methods that have recently become more apparent, with new approaches offering a way forward. Adrenal venous sampling (AVS) is a challenging procedure but is important for deciding on treatment options. Success rates may be improved by the use of Synacthen stimulation and of rapid intraprocedural measurement of cortisol. Better understanding of AVS interpretation criteria allows improved prognostication and aids treatment decisions. The use of labeled metomidate positron emission tomography computed tomography scanning may also offer an alternative to AVS in some units. Although the diagnostic approach to patients with primary aldosteronism remains a complex multistep process in which attention to detail is important, recent advances will improve patient care and outcomes.

Renin angiotensin aldosterone system altered in resistant hypertension in Sub-Saharan African diabetes patients without evidence of primary hyperaldosteronism.

BackgroundThe renin-angiotensin-aldosterone system may be altered in patients with resistant hypertension. This study aimed to evaluate the relation between renin-angiotensin-aldosterone system activity and resistant hypertension in Cameroonian diabetes patients with resistant hypertension.MethodsWe carried out a case-control study including 19 diabetes patients with resistant hypertension and 19 diabetes patients with controlled hypertension matched to cases according to age, sex and duration of hypertension since diagnosis. After collection of data, fasting blood was collected for measurement of sodium, potassium, chloride, active renin and plasma aldosterone of which the aldosterone-renin ratio was derived to assess the activity of renin-angiotensin-aldosterone system. Then, each participant received 2000 ml infusion of saline solution after which plasma aldosterone was re-assayed.ResultsPotassium levels were lower among cases compared to controls (mean: (4.10 ± 0.63 mmol/l vs. 4.47 ± 0.58 mmol/l), though nonsignificant (p = 0.065). Active renin, plasma aldosterone both before and after the dynamic test and aldosterone-renin ratio were comparable between cases and controls (all p values > 0.05). Plasma aldosterone significantly decreased after the dynamic test in both groups (p < 0.001), but no participant exhibited a post-test value>280 pmol/l. We found a significant negative correlation between potassium ion and plasma aldosterone (ρ = −0.324; p = 0.047), the other correlations being weak and unsignificant.ConclusionAlthough this study failed to show an association between RH and primary hyperaldosteronism in our context, there was a hyperactivity of renin-angiotensin-aldosterone system. Moreover, this study confirms the importance of potassium dosage when screening the renin-angiotensin-aldosterone system.

Metabolic Syndrome among Ischaemic Stroke Patients in Ghana: The Possible Role of Renin and Aldosterone

Background: Both metabolic syndrome (MetSyn) and the Renin Angiotensin Aldosterone System (RAAS) are predictors of adverse outcomes in stroke patients. This study aimed at evaluating the association between RAAS and MetSyn among ischaemic stroke subjects in a tertiary hospital of Ghana from September 2015 to June 2016. Methodology: The study purposively recruited 252 Ghanaians comprising 132 ischaemic stroke patients and 120 apparently healthy control subjects. The participants were subjected to measurements of plasma renin, serum aldosterone, lipid profile, anthropometries and blood pressure. Results: MetSyn prevalence among the stroke subjects compared to the controls were 50.0% vs 8.3% (NCEP/ATP III), 71.2% vs 9.2 (IDF) and 71.2% vs 6.7% (H_MS). Both renin and aldosterone were significantly (p 3) aldosterone (aOR = 2.7, p = 0.008), obesity (aOR = 11.7, p = 0.004) and high triglyceride (aOR = 5.3, p p = 0.742) were independently associated with increasing odds of metabolic syndrome. Moreover, there was a significant (p p

Guidelines for primary aldosteronism: uptake by primary care physicians in Europe.

Primary aldosteronism is the most frequent form of secondary hypertension but is still markedly underdiagnosed. In 2008, the Endocrine Society released guidelines for primary aldosteronism diagnosis and management; current indications are that they are not being widely followed. To investigate the level of knowledge and application of the guidelines in a large representative cohort of general practitioners (GPs) in Italy and Germany. The study was carried out by web questionnaire on hypertension and primary aldosteronism management with 500 GPs (250 in Italy and 250 in Germany), stratified by geographical area and city size. The mean number of patients seen was 1747 (Germany) and 1388 (Italy). Of these, 18% were diagnosed as hypertensive in Italy and 25% in Germany. Renin and aldosterone measurements were ordered by 7% of GPs in Italy and 8% in Germany. GPs in Italy considered 8% of patients eligible for aldosterone and renin measurements compared with 13% of GPs in Germany. In Italy, primary aldosteronism prevalence was 1% among hypertensive patients; 36% of the GPs reported no primary aldosteronism patients under their care or diagnosed previously. In Germany, the prevalence of primary aldosteronism was 2% among hypertensive patients; 19% of GPs had no primary aldosteronism patients. In Germany and in Italy, primary aldosteronism is not widely recognized by GPs; Endocrine Society guidelines for primary aldosteronism diagnosis are not well known or applied, resulting in marked underdiagnosis of the disease.

Hyponatraemia secondary to nivolumab-induced primary adrenal failure.

SummaryCheckpoint inhibitors, such as ipilimumab and pembrolizumab, have transformed the prognosis for patients with advanced malignant melanoma and squamous non-small-cell lung cancer, and their use will only expand as experience is gained in a variety of other malignancies, for instance, renal and lymphoma. As the use of checkpoint inhibitors increases, so too will the incidence of their unique side effects, termed immune-related adverse events (irAEs), which can affect dermatological, gastrointestinal, hepatic, endocrine and other systems. Nivolumab is a monoclonal antibody that blocks the human programmed death receptor-1 ligand (PD-L1) found on many cancer cells and is licensed for the treatment of advanced malignant melanoma. We describe the first case of nivolumab-induced adrenalitis resulting in primary adrenal failure presenting with hyponatraemia in a 43-year-old man with malignant melanoma. The case highlights the potentially life-threatening complications of checkpoint inhibitors and the need for patient education and awareness of irAEs among the wider clinical community because such side effects require prompt recognition and treatment.Learning points:Nivolumab can cause primary adrenal insufficiency.Not all cases of hyponatraemia in patients with malignancy are due to SIADH.Any patient on a checkpoint inhibitor becoming unwell should have serum cortisol urgently measured and if in doubt hydrocortisone therapy should be initiated.Although hyponatraemia can occur in patients with ACTH deficiency, the possibility of primary adrenal failure should also be considered and investigated by measurement of renin, aldosterone and ACTH.Patients receiving checkpoint inhibitors require education on the potential risks of hypocortisolaemia.PET imaging demonstrated bilateral increased activity consistent with an autoimmune adrenalitis.

LBPS 02-61 GUIDELINES FOR PRIMARY ALDOSTERONISM

Objective: In 2008 the Endocrine Society published guidelines for the diagnosis and treatment of primary aldosteronism (PA), recommending screening testing in around 30% of the hypertensives. The present study was undertaken to establish the extent to which general practitioners (GPs) are aware of the guidelines and their familiarity with the management of PA. Design and Method: The study took place in Italy and Germany. A questionnaire was administered to 250 physicians in Italy and 250 in Germany by the market research firm Stethos srl. The physicians chosen cared for at least 1000 monitored patients. Results: The median of patients seen by each physician resulted to be 1,500 in both countries, 18% of which were hypertensives in Italy and 25% in Germany. Among hypertensive patients, 11% were considered to be affected by secondary hypertension (in 34.4% of cases attributed to an endocrine disease) and 7.6% displayed resistant hypertension in Italy; prevalence of secondary and resistant hypertension resulted 20% and 7.9% in Germany, respectively. At diagnosis of hypertension 50.4% of Italian GPs and 42.9% of German GPs request diagnostic tests to the patient; potassium levels are only requested by 43% GPs in Italy and 58% in Germany; renin and aldosterone measurement are required by around 8% of the GPs in both countries. Only 3% of the patients had the renin and aldosterone levels measured before the beginning of pharmacological therapy in both countries. In Italy, each GP follows an average of 3 PA patients, which results in a prevalence of PA of 1% among hypertensive patients; in Germany, each GP follows an average of 7 PA patients which results in a prevalence of PA of 2%. Conclusions: In conclusion, there is a significant gap between theory, as laid down in guidelines, and practice. It is likely that a similar gap exists throughout the world.

OP.3A.05] THE USE OF PREDICTION SCORE TO DIAGNOSE UNILATERAL DISEASE IN CHINESE PATIENTS WITH PRIMARY ALDOSTERONISM

Objective: Küpers et al.1 had proposed a clinical prediction scores to diagnose unilateral primary aldosteronism (PA). We aim to evaluate this prediction score in Chinese patients with PA. Design and method: 437 patients with PA who had received AVS between 2005 and 2015 were analyzed in this retrospective study. Results: Figure 1 is the flow chart of our patients with PA. According to Küpers’ prediction score, the best cutoff value to discriminate unilateral from bilateral disease in our cohort was 4 points. The area under the curve (AUC) of the score was 0.601 (95% CI 0.551–0.650), with the specificity of 53% and the sensitivity of 62%. We then analyzed in 148 patients who were normokalemia during the measurement of 24hour urinary and plasma aldosterone (64 with unilateral disease and 84 with bilateral disease)(Table 1) and modified the prediction score's components by counting the weight of 24hour urinary aldosterone, history of hypokalemia and > = 1 cm unilateral adenoma size on CT imaging (Table 2). We then found the best cut-off was 5 points with the sensitivity of 45.3% (95% CI 32.8–58.3%) and specificity of 90.5% (95% CI 82.1–95.8%). The AUC of our prediction score was 0.745 (95% CI 0.667–0.813), which is higher than that of Küpers’ score (0.635, 95% CI 0.552–0.713) (P = 0.003, Figure 2). Furthermore, according to our prediction score, the best cutoff was 5 points in patients who had right adrenal lesion on CT imaging, with the specificity of 100% (95% CI 71.5–100%) and the sensitivity of 53% (95% CI 26.6–78.7%). In patients younger than 40 years old, the best cutoff was 6 points, with the specificity of 100% (95% CI 75.3–100%) and the sensitivity of 23.5% (95% CI 6.8–49.9%) (Figure 3). Conclusions: Küpers’ prediction score is not suitable for Chinese patients with PA. Our modified prediction score can efficiently identify unilateral aldosteronism in patients showing right adenoma on CT and patients younger than 40 years old.

Determination of urinary aldosterone using a plasma aldosterone 2D ID LC-MS/MS method.

In the diagnosis for primary aldosteronism, the measurement of urinary aldosterone is part of the confirmation test but diagnostic accuracy may be blunted due to poor immunoassay performance for urinary aldosterone. Nowadays, plasma aldosterone concentrations are measured preferably by LC-MS/MS yet such methods for urinary aldosterone are lacking. We show that plasma and urinary aldosterone can be measured with the same 2D isotope dilution LC-MS/MS method. The accuracy of the method was tested against a certified reference material. The reference values for plasma and urinary aldosterone were established. With this method, urinary aldosterone concentrations can be measured precisely, simply and accurately together with plasma samples with one set of calibration standards.

Hiperaldosteronismo e hipoaldosteronismo

IntroductionAldosterone is a mineralocorticoid hormone which regulates the sodium homeostasis, the plasma volume and the blood pressure. EtiopathogeniaHypoaldosteronisms are a group of syndromes characterized by decreased levels of aldosterone (or resistance to its action). Primary hyperaldosteronisms have elevated levels of aldosterone and decreased of levels of renin, mainly due to primary adrenal hyperplasia (60%) or an aldosteronoma (30%). Clinical ManifestationsHypoaldosteronisms present with hyponatremia, natriuresis, hypovolemia and hyperkalemia/metabolic acidosis. Hyperaldosteronisms produce hypertension, sometimes with hypokalemia and metabolic alkalosis. DiagnosisThe association with a deficit of glucocorticoid should be discarded. The measurement of aldosterone and renin (basal / after stimulus) is necessary to guide the hypoaldosteronism diagnosis. The diagnosis of hyperaldosteronism requires a positive screening test and also a confirmation test; for differential diagnosis we should use adrenal CT and catheterization. TreatmentIn hypoaldosteronisms it is necessary to treat the precipitating cause and to administrate fludrocortisone. In hyperaldosteronisms the patient must be referred for surgery or treated with aldosterone antagonists according to the localization exams.

Ten minutes simultaneous measurement of aldosterone and active renin concentration may lead to a proper selection of antihypertensive agents for the patients

Ten minutes simultaneous measurement of aldosterone and active renin concentration may lead to a proper selection of antihypertensive agents for the patients

Mass Spectrometry-Based Adrenal and Peripheral Venous Steroid Profiling for Subtyping Primary Aldosteronism.

Differentiating patients with primary aldosteronism caused by aldosterone-producing adenomas (APAs) from those with bilateral adrenal hyperplasia (BAH), which is essential for choice of therapeutic intervention, relies on adrenal venous sampling (AVS)-based measurements of aldosterone and cortisol. We assessed the utility of LC-MS/MS-based steroid profiling to stratify patients with primary aldosteronism. Fifteen adrenal steroids were measured by LC-MS/MS in peripheral and adrenal venous plasma from AVS studies for 216 patients with primary aldosteronism at 3 tertiary referral centers. Ninety patients were diagnosed with BAH and 126 with APAs on the basis of immunoassay-derived adrenal venous aldosterone lateralization ratios. Among 119 patients confirmed to have APAs at follow-up, LC-MS/MS-derived lateralization ratios of aldosterone normalized to cortisol, dehydroepiandrosterone, and androstenedione were all higher (P < 0.0001) than immunoassay-derived ratios. The hybrid steroids, 18-oxocortisol and 18-hydroxycortisol, also showed lateralized secretion in 76% and 35% of patients with APAs. Adrenal venous concentrations of glucocorticoids and androgens were bilaterally higher in patients with BAH than in those with APAs. Consequently, peripheral plasma concentrations of 18-oxocortisol were 8.5-fold higher, whereas concentrations of cortisol, corticosterone, and dehydroepiandrosterone were lower in patients with APAs than in those with BAH. Correct classification of 80% of cases of APAs vs BAH was thereby possible by use of a combination of steroids in peripheral plasma. LC-MS/MS-based steroid profiling during AVS achieves higher aldosterone lateralization ratios in patients with APAs than immunoassay. LC-MS/MS also enables multiple measures for discriminating unilateral from bilateral aldosterone excess, with potential use of peripheral plasma for subtype classification.

Activating mutations in CTNNB1 in aldosterone producing adenomas.

Primary aldosteronism (PA) is the most common cause of secondary hypertension with a prevalence of 5–10% in unreferred hypertensive patients. Aldosterone producing adenomas (APAs) constitute a large proportion of PA cases and represent a surgically correctable form of the disease. The WNT signaling pathway is activated in APAs. In other tumors, a frequent cause of aberrant WNT signaling is mutation in the CTNNB1 gene coding for β-catenin. Our objective was to screen for CTNNB1 mutations in a well-characterized cohort of 198 APAs. Somatic CTNNB1 mutations were detected in 5.1% of the tumors, occurring mutually exclusive from mutations in KCNJ5, ATP1A1, ATP2B3 and CACNA1D. All of the observed mutations altered serine/threonine residues in the GSK3β binding domain in exon 3. The mutations were associated with stabilized β-catenin and increased AXIN2 expression, suggesting activation of WNT signaling. By CYP11B2 mRNA expression, CYP11B2 protein expression, and direct measurement of aldosterone in tumor tissue, we confirmed the ability for aldosterone production. This report provides compelling evidence that aberrant WNT signaling caused by mutations in CTNNB1 occur in APAs. This also suggests that other mechanisms that constitutively activate the WNT pathway may be important in APA formation.

Evaluation of aldosterone excretion in very low birth weight infants.

Data about aldosterone production and excretion in the neonatal period are still few and controversial. Our objectives are to assess urinary aldosterone excretion (UAE) in very low birth weight (VLBW) infants and to identify clinical and biochemical variables that may influence this excretion. Thirty VLBW infants (14 males and 16 females), their gestational age <32 weeks and body weight <1500 g, were included in the study. Demographic and clinical data were recorded, within the first 72 h of life and urine and blood samples were collected for the measurement of urinary aldosterone and serum potassium, sodium, and chloride. The mean UAE value was 0.176 ± 0.05 μg/24 h and the mean absolute UAE was 1906 ± 271 pg/mL. There was a statistically significant positive correlation between UAE and gestational age and birth weight; also, infants with respiratory distress syndrome had higher urinary aldosterone levels than infants without respiratory distress. Only plasma sodium was a significant independent factor that negatively influenced UAE on linear regression analysis. The renin-angiotensin-aldosterone system of VLBW infants seems to be able, even immediately after birth, to respond to variations of plasma sodium concentrations; measurement of UAE constitutes an interesting method to determine aldosterone production in VLBW infants.

Quantitation of Aldosterone in Serum or Plasma Using Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS).

Accurate determination of serum and plasma aldosterone is essential for screening, diagnosis, and subtype classification of primary aldosteronism (PA). Its measurement is also used in the investigation of adrenal incidentaloma, adrenal carcinoma, Addison's disease, congenital adrenal hyperplasia, renal artery stenosis, and renal tubular channelopathies. We describe a simple and robust method for the accurate and precise measurement of aldosterone in serum or plasma using liquid chromatography and tandem mass spectrometry (LC-MS/MS). After addition of internal standard, aldosterone is extracted from serum samples using supported liquid extraction (SLE) with methyl-t-butyl ether (MtBE). The MtBE is evaporated to dryness and sample is reconstituted with mobile phase before injection onto the LC-MS/MS and quantitation using an 8-point calibration curve. The assay calibration range is approximately 50-6500 pmol/L (0.16-234 ng/dL) with total imprecision between 6.8 and 4.1 % for concentrations between about 50 and 1000 pmol/L respectively.

Establishment of reference intervals for aldosterone and renin in a Caucasian population using the newly developed Immunodiagnostic Systems specialty immunoassay automated system.

Measurement of aldosterone and/or renin is essential to aid the differential diagnosis of secondary hypertension, guide strategy for therapeutic management of hypertension and assess adequacy of mineralocorticoid replacement. The objective was to establish normative data for aldosterone and renin using the Immunodiagnostic Systems specialty immunoassay system platform in a Caucasian population. Following informed consent, 365 subjects were recruited to this study. Subjects were ambulatory and attended clinic for blood pressure measurement and phlebotomy between the hours of 7:00 and 11:00. Blood pressure was measured according to the 2013 European Society of Hypertension/Cardiology guidelines. The inclusion criteria: age ≥18 years, BMI <30 kg/m(2), non-pregnant, blood pressure <140/90, normal electrolytes and kidney function and not taking prescribed/over the counter medications. Ninety-four subjects were excluded based on these criteria. A total of 271 volunteers (females n = 145), aged 18-65 years formed the reference cohort. Blood for aldosterone/renin was collected into ethylenediaminetetraacetic acid specimen tubes. Samples were kept at room temperature and transported within 30 min of blood draw to the laboratory for immediate processing (centrifugation, separation and freezing of plasma). Plasma was stored at -20℃ prior to analysis on the Immunodiagnostic Systems specialty immunoassay system instrument. The established reference intervals in an Irish Caucasian population for renin: females: 6.1-62.7 mIU/L, males: 9.0-103 mIU/L, for aldosterone: females: <138-1179 pmol/L, males: <138-670 pmol/L, respectively. This study demonstrates that reference intervals for aldosterone and renin should be gender specific. These automated immunoassays offer rapid stratification of patients with refractory hypertension and will better facilitate the optimization of therapeutic management.

Measurement of serum aldosterone in picomolar level by LC-MS/MS using charge-tagged technique.

Aldosterone is a mineralocorticoid steroid hormone, the measurement of which in the clinical laboratory is principally performed for the investigation of primary hyperaldosteronism. Primary hyperaldosteronism is a specifically treatable and potentially curable form of hypertension, which typically presents as drug-resistant hypertension and, in up to 37% of cases, hypokalemia. Accurate measurement of aldosterone concentration is essential for correct diagnosis. The serum concentrations of aldosterone are in the picomolar range and therefore sensitive aldosterone assays are required. With the advancement in instrumentation of LC-MS/MS, the picomolar range of aldosterone can be easily measured by the newer models, but for those with a less sensitive instrument, special technique for sample preparation to enhance assay sensitivity is required. This work described the use of charge-tagging for the picomolar measurement of serum aldosterone in a less sensitive LC-MS/MS instrument. The assay was linear up to 3000 pmol/L with lower limit of quantitation at 80 pmol/L. The mean relative recovery was 96.5% with a range of 89.3-101.6% for aqueous calibrators and the mean relative recovery was 94.8% with a range of 87.5-101.4% for serum calibrators. Intra-assay CVs range from 8.2% to 11.3%, and inter-assay CVs ranged from 8.5% to 13.5% at concentration range from 229 to 1720 pmol/L. The LC-MS/MS method compared well (y = 1.04x + 8.97) with the in-use radioimmunoassay method. There was no significant difference found (p = 0.7135) between results determined by LC-MS/MS and radioimmunoassay method.

Abstract P210: Association of Perceived Stress and Aldosterone and Adiponectin Levels in a Rural Cohort of African Americans

African Americans (AA) have the highest prevalent rates of ESRD than any other group in this country. AA males have the highest risk with more than a two-fold greater risk of kidney injury compared to their female counterparts. The underlying pathophysiology that predisposes AA males to renal injury remains to be definitively determined. However, recent findings from our laboratory have shown that stress may exacerbate the renal injury associated with hypertension. Using an animal model of nitric oxide deficiency hypertension we showed that renal injury associated with this model of hypertension was increased following four weeks of intermittent stress (Pointer et al. 2012). The current study sought to determine whether we could find a similar association of stress and renal injury in a population prone to renal injury. To achieve this we recruited African Americans (11 males; 36 females) attending a health fair. We administered a perceived stress scale; measured resting blood pressure; and collected a blood sample for cortisol, adiponectin, and aldosterone measurement. Aldosterone (ALDO) is a hormone released from the adrenal gland in response to stress. ALDO levels have been linked to increased cardiovascular injury such as acute myocardial infarction and kidney disease. Adiponectin is an adipokine and appears to have protective actions in metabolic disease. In this sampling we found that non-normotensive (blood pressure above 120/80 mmHg) AA females had similar PSS scores as the males (24 ± 2 vs. 21 ± 2) and similar plasma cortisol levels (9.4 ± 0.5 vs. 9.8 ± 1μg/dL, respectively). However, in males cortisol was positively associated with ALDO (p=0.032) and negatively associated with adiponectin (p&lt;0.03). There was no significant association of cortisol with ALDO and adiponectin in females. These findings suggest that AA males may be predisposed to renal injury as a consequence of stress leading to 1) increased injury promoting (ALDO) and 2) decreased disease protective (adiponectin) agents. Further studies are needed to confirm these findings in a larger sampling.

Association of Post-Saline Load Plasma Aldosterone Levels With Left Ventricular Hypertrophy in Primary Hypertension.

Left ventricular hypertrophy (LVH) is an independent risk factor for cardiovascular morbidity in hypertension. Current evidence suggests a contribution to LVH of plasma aldosterone levels that are inappropriately elevated for the salt status. The aim of this study was to investigate whether inappropriate modulation of aldosterone production by a saline load is associated with left ventricular (LV) mass in hypertensive patients. In 90 hypertensive patients free of clinically relevant cardiovascular complications in whom secondary forms of hypertension were ruled out, we performed a standard intravenous saline load (0.9% NaCl, 2 l in 4 hours) with measurement of plasma aldosterone and active renin at baseline and end of infusion. Bi-dimensional echocardiography was performed for the assessment of cardiac morphology and function. LVH was present in 19% of patients who had significantly worse renal function and higher body mass, blood pressure, and plasma aldosterone levels measured both at baseline and after the saline load than patients without LVH. LV mass was directly related to age, body mass, systolic blood pressure, duration of hypertension, baseline, and post-saline load plasma aldosterone levels and inversely to glomerular filtration. Multivariate regression analysis showed independent correlation of LV mass with body mass, systolic blood pressure, and plasma aldosterone levels measured after intravenous saline load, but not at baseline. In patients with hypertension, aldosterone levels measured after intravenous saline load are related to LV mass independent of age, body mass, and blood pressure, suggesting that limited ability of salt to modulate aldosterone production could contribute to LVH.