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Sabbadin C, Saccardi C, Andrisani A, Vitagliano A, Marin L, Ragazzi E, Bordin L, Ambrosini G, Armanini D. Role of Renin-Angiotensin-Aldosterone System and Cortisol in Endometriosis: A Preliminary Report. Int J Mol Sci 2022; 24:ijms24010310. [PMID: 36613755 PMCID: PMC9820500 DOI: 10.3390/ijms24010310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
Endometriosis is a chronic inflammatory disease associated with pelvic pain, infertility, and increased cardiovascular risk. Recent studies suggest a possible role of aldosterone as a pro-inflammatory hormone in the pathogenesis of the disease. Cortisol is also an important mediator of stress reaction, but its role is controversial in endometriosis. The aim of this study was to evaluate aldosterone and cortisol levels and blood pressure values in women with endometriosis. We measured blood pressure, plasma aldosterone, renin, cortisol, and dehydroepiandrosterone sulfate (DHEAS) in 20 women with untreated minimal or mild pelvic endometriosis compared with 20 healthy controls matched for age and body mass index. Aldosterone values were similar in the two groups, while renin was significantly lower and the aldosterone to renin ratio was significantly higher in patients with endometriosis than in controls. Systolic blood pressure was in the normal range, but significantly higher in patients with endometriosis. Morning plasma cortisol was normal, but significantly lower in patients with endometriosis compared with controls, while DHEAS to cortisol ratio was similar in the two groups. These preliminary results are evidence of increased biological aldosterone activity and dysregulation of the hypothalamic-pituitary-adrenal axis in early stages of endometriosis. These alterations could play a role in disease development, suggesting new therapeutic targets for aldosterone receptor blockers.
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Affiliation(s)
- Chiara Sabbadin
- Endocrinology Unit, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Carlo Saccardi
- Department of Women’s and Children’s Health, University of Padova, 35128 Padova, Italy
| | - Alessandra Andrisani
- Department of Women’s and Children’s Health, University of Padova, 35128 Padova, Italy
| | - Amerigo Vitagliano
- Department of Women’s and Children’s Health, University of Padova, 35128 Padova, Italy
| | - Loris Marin
- Department of Women’s and Children’s Health, University of Padova, 35128 Padova, Italy
| | - Eugenio Ragazzi
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, 35131 Padova, Italy
| | - Luciana Bordin
- Department of Molecular Medicine-Biological Chemistry, University of Padova, 35131 Padova, Italy
| | - Guido Ambrosini
- Department of Women’s and Children’s Health, University of Padova, 35128 Padova, Italy
| | - Decio Armanini
- Endocrinology Unit, Department of Medicine, University of Padova, 35128 Padova, Italy
- Correspondence:
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Imaging or Adrenal Vein Sampling Approach in Primary Aldosteronism? A Patient-Based Approach. Tomography 2022; 8:2735-2748. [PMID: 36412687 PMCID: PMC9680373 DOI: 10.3390/tomography8060228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/05/2022] [Accepted: 11/08/2022] [Indexed: 11/11/2022] Open
Abstract
Primary aldosteronism (PA) is the most frequent cause of secondary hypertension, associated with an increased risk of cardiovascular and cerebral disease, compared to essential hypertension. Therefore, it is mandatory to promptly recognize the disease and offer to the patient the correct diagnostic-therapeutic process in order to reduce new-onset cardiovascular events. It is fundamental to define subtype classification (unilateral or bilateral disease), in order to provide the best treatment (surgery for unilateral and medical treatment for bilateral disease). Here, we report five clinical cases of different subtypes of PA (patients with monolateral or bilateral PA, nondiagnostic AVS, allergy to iodinated contrast, and patients not suitable for surgery), with particular attention to the diagnostic-therapeutic process and the different approaches tailored to a single case. Since PA is a spectrum of various diseases, it needs a personalized diagnostic-therapeutic process, customized for the individual patient, depending on previous medical history, suitability for the surgery and patient's preferences.
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Salvetti M, Paini A, Bertacchini F, Aggiusti C, Stassaldi D, Capellini S, Arnoldi C, Rizzoni D, Agabiti Rosei C, De Ciuceis C, Muiesan ML. Myocardial mechano-energetic efficiency in primary aldosteronism. J Hypertens 2021; 39:318-324. [PMID: 32868642 DOI: 10.1097/hjh.0000000000002637] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Available data indicate that patients with primary aldosteronism have an increased risk of cardiovascular events and cardiovascular risk seems to be, at least in part, independent of blood pressure (BP) values. Patients with primary aldosteronism have a greater prevalence of left ventricular (LV) hypertrophy and subtle alterations of ventricular function, which might contribute to the increase in cardiovascular risk. Recently, a noninvasive approach for the estimation of LV mechanical efficiency, obtained by echocardiography has been proposed. AIM OF THE STUDY To evaluate the determinants of myocardial mechanoenergetic efficiency index (MEEi), in a large group of patients with primary aldosteronism (n = 99) and in a control group of essential hypertensive patients (n = 99) matched for age, sex and BP values. RESULTS No differences between groups for age, sex, BMI, BP values, glucose, lipid profile and renal function were observed. LV mass index was greater in primary aldosteronism vs. essential hypertensive patients (46.0 ± 16.7 vs. 36.9 ± 8.6 g/m2, P < 0.001); also relative wall thickness was greater in primary aldosteronism (0.36 ± 0.1 vs. 0.32 ± 0.4, P < 0.001). Left atrial dimensions were significantly greater in primary aldosteronism. Ejection fraction was not different between groups, while endocardial and midwall fractional shortening were lower in primary aldosteronism vs. essential hypertensive patients (40 ± 7 vs. 43 ± 6, and 18 ± 3 vs. 21 ± 2, both P < 0.01). MEEi was lower in primary aldosteronism vs. essential hypertensive patients (0.44 ± 0.14 vs. 0.52 ± 0.10 ml/s per g, P < 0.01). A negative correlation was observed between MEEi and aldosterone levels (r = -0.203, P < 0.05) and aldosterone : renin ratio (P = -0.172, P < 0.05); the correlation remained significant after adjustment for possible confounders. CONCLUSION In patients with primary aldosteronism myocardial MEEi is lower as compared with essential hypertensive patients. A reduced MEEi may reflect an impairment of production and utilization of energy in the myocardium, which could lead to the occurrence of cardiovascular complications and therefore these findings may contribute to explain the increased risk of cardiovascular events in patients with primary aldosteronism.
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Affiliation(s)
- Massimo Salvetti
- 2a Medicina ASST Spedali Civili di Brescia
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Anna Paini
- 2a Medicina ASST Spedali Civili di Brescia
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Fabio Bertacchini
- 2a Medicina ASST Spedali Civili di Brescia
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Carlo Aggiusti
- 2a Medicina ASST Spedali Civili di Brescia
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Deborah Stassaldi
- 2a Medicina ASST Spedali Civili di Brescia
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Sara Capellini
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Chiara Arnoldi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Damiano Rizzoni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Claudia Agabiti Rosei
- 2a Medicina ASST Spedali Civili di Brescia
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Carolina De Ciuceis
- 2a Medicina ASST Spedali Civili di Brescia
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Maria Lorenza Muiesan
- 2a Medicina ASST Spedali Civili di Brescia
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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Armanini D, Bordin L, Donà G, Andrisani A, Ambrosini G, Boscaro M, Sabbadin C. Evaluation and implications of salt intake and excretion. J Clin Hypertens (Greenwich) 2019; 21:950-952. [PMID: 31243867 DOI: 10.1111/jch.13589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Decio Armanini
- Department of Medicine-Endocrinology, University of Padova, Padova, Italy
| | - Luciana Bordin
- Department of Molecular Medicine-Biological Chemistry, University of Padova, Padova, Italy
| | - Gabriella Donà
- Department of Molecular Medicine-Biological Chemistry, University of Padova, Padova, Italy
| | - Alessandra Andrisani
- Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Guido Ambrosini
- Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Marco Boscaro
- Department of Medicine-Endocrinology, University of Padova, Padova, Italy
| | - Chiara Sabbadin
- Department of Medicine-Endocrinology, University of Padova, Padova, Italy
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Ding X, Jia N, Zhao C, Zhong Y, Dai D, Zhao Y, Xu C, Cai J, Wang Q, He Q. A family with Liddle's syndrome caused by a new c.1721 deletion mutation in the epithelial sodium channel β-subunit. Exp Ther Med 2019; 17:2777-2784. [PMID: 30930974 DOI: 10.3892/etm.2019.7270] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 11/01/2018] [Indexed: 11/06/2022] Open
Abstract
A 19-year-old male with early refractory hypertension, hypokalemia, serum potassium level of 3.4 mmol/l and hypoaldosteronemia was indicated in the present study. According to the results of laboratory tests and examinations, the patient was suspected of having Liddle's syndrome (LS). Genetic analysis of SCNN1B revealed a deletion mutation (c.1721delC). This mutation caused a length extension of SCNN1B coding sequence, which resulted in p.Pro574HisfsX675. A total of 34 family members were enrolled in the study and 29 of these family members underwent genetic testing. A total of 10 family members were clinically diagnosed with hypertension. Notably, 5 family members shared the same gene mutation as the proband and all cases with the mutation had hypertension. Blood pressure of the gene mutation carriers was well controlled by tailored treatment. In conclusion, a patient with early onset and refractory hypertension, hypokalemia and hypoaldosteronemia was diagnosed clinically and genetically with LS. Notably, a novel mutation (c.1721delC) was identified by DNA analysis. The present findings indicate that genetic analysis is useful, not only in the diagnosis of LS, but also in designing a tailored treatment.
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Affiliation(s)
- Xia Ding
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Beijing 100730, P.R. China.,Department of Nephrology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Na Jia
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Beijing 100730, P.R. China
| | - Cong Zhao
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Beijing 100730, P.R. China
| | - You Zhong
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Beijing 100730, P.R. China
| | - Dapeng Dai
- The Key Laboratory of Geriatrics, Beijing Hospital and Beijing Institute of Geriatrics, Ministry of Health, Beijing 100730, P.R. China
| | - Yuanyuan Zhao
- Human Genome Research Center and College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, Hubei 430074, P.R. China
| | - Chengqi Xu
- Human Genome Research Center and College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, Hubei 430074, P.R. China
| | - Jianping Cai
- The Key Laboratory of Geriatrics, Beijing Hospital and Beijing Institute of Geriatrics, Ministry of Health, Beijing 100730, P.R. China
| | - Qing Wang
- Human Genome Research Center and College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, Hubei 430074, P.R. China
| | - Qing He
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Beijing 100730, P.R. China
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Liu K, Wang B, Ma X, Li H, Zhang Y, Li J, Yao Y, Tang L, Xuan Y, Guo A, Zhang X. Minimally Invasive Surgery-Based Multidisciplinary Clinical Management of Reninoma: A Single-Center Study. Med Sci Monit 2019; 25:1600-1610. [PMID: 30822300 PMCID: PMC6407327 DOI: 10.12659/msm.913826] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background This article presents our experience in managing a rare kidney tumor – reninoma – by analyzing a relatively large series of cases from a single center. Material/Methods Nine cases of reninoma were reviewed. Clinical manifestations, imaging examinations, laboratory examinations, perioperative data, and pathological findings were summarized. A 58.8-month follow-up was performed to evaluate patient survival and recrudescence. Results The main clinical manifestations were hypertension, hypokalemia, headache, dizziness, nausea, vomiting, palpation, and sweating. Three patients had hypertensive end-organ damage, including brain hemorrhage, gestation termination, and grade III ocular fundus changes. All patients underwent retroperitoneal laparoscopic partial nephrectomy successfully. The mean warm ischemic time was 23.4 min. The median operation time was 95.1 min, with a median estimated blood loss of 60 ml. The median hospital stay was 6 days. No serious intraoperative or postoperative complications occurred. The histology and electron microscopy findings confirmed the diagnosis of reninoma in all cases. After 58.8 months of follow-up, symptoms involving hypertension were relieved in all patients, and no tumor recurrence or metastasis was detected. Conclusions Reninoma may have severe consequences despite being a benign tumor. Retroperitoneal laparoscopic partial nephrectomy is a feasible and effective method for the surgical removal of reninoma. Multidisciplinary cooperation plays an important role in improving the diagnosis and enabling the early surgical treatment of reninoma. Especially in cases of reninoma with moderate and high RENAL scores, an accurate diagnosis of reninoma based on multidisciplinary cooperation facilitates the selection of less invasive surgical approaches.
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Affiliation(s)
- Kan Liu
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese People's Liberation Army (PLA) General Hospital/Chinese PLA Medical Academy, Beijing, China (mainland)
| | - Baojun Wang
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese People's Liberation Army (PLA) General Hospital/Chinese PLA Medical Academy, Beijing, China (mainland)
| | - Xin Ma
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese People's Liberation Army (PLA) General Hospital/Chinese PLA Medical Academy, Beijing, China (mainland)
| | - Hongzhao Li
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese People's Liberation Army (PLA) General Hospital/Chinese PLA Medical Academy, Beijing, China (mainland)
| | - Yu Zhang
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese People's Liberation Army (PLA) General Hospital/Chinese PLA Medical Academy, Beijing, China (mainland)
| | - Jinlong Li
- Department of Pathology, Chinese People's Liberation Army (PLA) General Hospital/Chinese PLA Medical Academy, Beijing, China (mainland)
| | - Yuanxin Yao
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese People's Liberation Army (PLA) General Hospital/Chinese PLA Medical Academy, Beijing, China (mainland)
| | - Lu Tang
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese People's Liberation Army (PLA) General Hospital/Chinese PLA Medical Academy, Beijing, China (mainland)
| | - Yundong Xuan
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese People's Liberation Army (PLA) General Hospital/Chinese PLA Medical Academy, Beijing, China (mainland)
| | - Aitao Guo
- Department of Pathology, State Key Laboratory of Kidney Diseases, Chinese People's Liberation Army (PLA) General Hospital/Chinese PLA Medical Academy, Beijing, China (mainland)
| | - Xu Zhang
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese People's Liberation Army (PLA) General Hospital/Chinese PLA Medical Academy, Beijing, China (mainland)
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Secondary Arterial Hypertension: From Routine Clinical Practice to Evidence in Patients with Adrenal Tumor. High Blood Press Cardiovasc Prev 2018; 25:345-354. [DOI: 10.1007/s40292-018-0288-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 10/31/2018] [Indexed: 12/24/2022] Open
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Armanini D, Bordin L, Dona' G, Andrisani A, Ambrosini G, Sabbadin C. Relationship between water and salt intake, osmolality, vasopressin, and aldosterone in the regulation of blood pressure. J Clin Hypertens (Greenwich) 2018; 20:1455-1457. [PMID: 30232837 DOI: 10.1111/jch.13379] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Decio Armanini
- Department of Medicine - Endocrinology (DIMED), University of Padua, Padua, Italy
| | - Luciana Bordin
- Department of Molecular Medicine - Biological Chemistry, University of Padua, Padua, Italy
| | - Gabriella Dona'
- Department of Molecular Medicine - Biological Chemistry, University of Padua, Padua, Italy
| | | | - Guido Ambrosini
- Department of Women's Health-Salus Pueri, University of Padua, Padua, Italy
| | - Chiara Sabbadin
- Department of Medicine - Endocrinology (DIMED), University of Padua, Padua, Italy
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