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.

Plasma Renin Measurements are Unrelated to Mineralocorticoid Replacement Dose in Patients With Primary Adrenal Insufficiency / Pofi, Riccardo; Prete, Alessandro; Thornton-Jones, Vivien; Bryce, Jillian; Ali, Salma R; Faisal Ahmed, S; Balsamo, Antonio; Baronio, Federico; Cannuccia, Amalia; Guven, Ayla; Guran, Tulay; Darendeliler, Feyza; Higham, Claire; Bonfig, Walter; de Vries, Liat; Bachega, Tania A S S; Miranda, Mirela C; Mendonca, Berenice B; Iotova, Violeta; Korbonits, Màrta; Krone, Nils P; Krone, Ruth; Lenzi, Andrea; Arlt, Wiebke; Ross, Richard J; Isidori, Andrea M; Tomlinson, Jeremy W. - In: THE JOURNAL OF CLINICAL ENDOCRINOLOGY AND METABOLISM. - ISSN 0021-972X. - 105:1(2020). [10.1210/clinem/dgz055]

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

Pofi, Riccardo;Lenzi, Andrea;Isidori, Andrea M;
2020

Abstract

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.
2020
Congenital Adrenal Hyperplasia, salt-wasting CAH, primary adrenal insufficiency, Mineralocorticoid replacement, plasma renin concentration, Fludrocortisone
01 Pubblicazione su rivista::01a Articolo in rivista
Plasma Renin Measurements are Unrelated to Mineralocorticoid Replacement Dose in Patients With Primary Adrenal Insufficiency / Pofi, Riccardo; Prete, Alessandro; Thornton-Jones, Vivien; Bryce, Jillian; Ali, Salma R; Faisal Ahmed, S; Balsamo, Antonio; Baronio, Federico; Cannuccia, Amalia; Guven, Ayla; Guran, Tulay; Darendeliler, Feyza; Higham, Claire; Bonfig, Walter; de Vries, Liat; Bachega, Tania A S S; Miranda, Mirela C; Mendonca, Berenice B; Iotova, Violeta; Korbonits, Màrta; Krone, Nils P; Krone, Ruth; Lenzi, Andrea; Arlt, Wiebke; Ross, Richard J; Isidori, Andrea M; Tomlinson, Jeremy W. - In: THE JOURNAL OF CLINICAL ENDOCRINOLOGY AND METABOLISM. - ISSN 0021-972X. - 105:1(2020). [10.1210/clinem/dgz055]
File allegati a questo prodotto
File Dimensione Formato  
Pofi_Plasma-renin_2020.pdf

solo gestori archivio

Tipologia: Versione editoriale (versione pubblicata con il layout dell'editore)
Licenza: Tutti i diritti riservati (All rights reserved)
Dimensione 372.43 kB
Formato Adobe PDF
372.43 kB Adobe PDF   Contatta l'autore

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1347830
Citazioni
  • ???jsp.display-item.citation.pmc??? 7
  • Scopus 30
  • ???jsp.display-item.citation.isi??? 29
social impact