Renin and electrolytes indicate the mineralocorticoid activity of fludrocortisone: a 6 year study in primary adrenal insufficiency
Context Fludrocortisone (FC) is the mineralocorticoid (MC) replacement treatment for patients with primary adrenal insufficiency (PAI). Objective To explore the dose of FC treatment and its relationship with glucocorticoid therapy, sodium, potassium, renin and clinical parameters. Setting Monocentri...
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| Veröffentlicht in: | Journal of endocrinological investigation 2023-01, Vol.46 (1), p.111-122 |
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| creator | Ceccato, F. Torchio, M. Tizianel, I. Peleg Falb, M. Barbot, M. Sabbadin, C. Betterle, C. Scaroni, C. |
| description | Context
Fludrocortisone (FC) is the mineralocorticoid (MC) replacement treatment for patients with primary adrenal insufficiency (PAI).
Objective
To explore the dose of FC treatment and its relationship with glucocorticoid therapy, sodium, potassium, renin and clinical parameters.
Setting
Monocentric cohort.
Patients
Data of 193 patients with PAI (130 autoimmune) were collected during baseline (T0), intermediate (T1) and last follow-up visit (T2, respectively, after a mean of 38 and 72 months).
Main outcome measure
Utility of endocrine and clinical parameters to titrate FC dose.
Results
FC dose (50–75 μg/daily) was stable in the follow-up in half patients. The MC activity of FC was dose-dependent: we observed a reduced but significant positive linear correlation between FC dose and sodium (
r
= 0.132) and negative linear correlation between FC and potassium (
r
= − 0.162) or renin (
r
= − 0.131, all
p
60 months,
p
|
| doi_str_mv | 10.1007/s40618-022-01889-1 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_9829625</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2700639584</sourcerecordid><originalsourceid>FETCH-LOGICAL-c404t-6a70514d8fd3b110688dab8bf9e10b40b03877a45c9089f3c70f977877f9b7183</originalsourceid><addsrcrecordid>eNp9kc1u1TAQhSMEoqXwAiyQJTZsAuM4iW0WSKjiT6qEhGBtOfa4dZVrF9uplDUvwrPwZPiSSyksWNmaOfPNHJ2meUzhOQXgL3IPIxUtdF0LVAjZ0jvNMeUdtIKJ8e6t_1HzIOdLAMaZ4PebIzbInndSHjffPmHwgehgCc5oSorzWjATH6w3uiApF0h2PmDSczQxFW-it0Sb4q99WUl0xM2LTVsvx4AviSbjj-8r6kRyWexaWeQq-Z1OK9E2YdBzLeXFOW88BrM-bO45PWd8dHhPmi9v33w-fd-efXz34fT1WWt66Es7ag4D7a1wlk2UwiiE1ZOYnEQKUw8TVHNc94ORIKRjhoOTnNeakxOngp00rzbu1TLt0BoMpbpSh9tU1F793Qn-Qp3HayVFJ8duqIBnB0CKXxfMRe18NjjPOmBcsuo4wMjkIPoqffqP9DIuqVrfq8ZOMjGIPbDbVCbFnBO6m2MoqH3GastY1YzVr4wVrUNPbtu4GfkdahWwTZBrK5xj-rP7P9if0JK2Bg</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2762938585</pqid></control><display><type>article</type><title>Renin and electrolytes indicate the mineralocorticoid activity of fludrocortisone: a 6 year study in primary adrenal insufficiency</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Ceccato, F. ; Torchio, M. ; Tizianel, I. ; Peleg Falb, M. ; Barbot, M. ; Sabbadin, C. ; Betterle, C. ; Scaroni, C.</creator><creatorcontrib>Ceccato, F. ; Torchio, M. ; Tizianel, I. ; Peleg Falb, M. ; Barbot, M. ; Sabbadin, C. ; Betterle, C. ; Scaroni, C.</creatorcontrib><description>Context
Fludrocortisone (FC) is the mineralocorticoid (MC) replacement treatment for patients with primary adrenal insufficiency (PAI).
Objective
To explore the dose of FC treatment and its relationship with glucocorticoid therapy, sodium, potassium, renin and clinical parameters.
Setting
Monocentric cohort.
Patients
Data of 193 patients with PAI (130 autoimmune) were collected during baseline (T0), intermediate (T1) and last follow-up visit (T2, respectively, after a mean of 38 and 72 months).
Main outcome measure
Utility of endocrine and clinical parameters to titrate FC dose.
Results
FC dose (50–75 μg/daily) was stable in the follow-up in half patients. The MC activity of FC was dose-dependent: we observed a reduced but significant positive linear correlation between FC dose and sodium (
r
= 0.132) and negative linear correlation between FC and potassium (
r
= − 0.162) or renin (
r
= − 0.131, all
p
< 0.01). An overall reduction in the FC dose was observed at T2 in the group with longer follow-up (> 60 months,
p
< 0.05). Higher doses of FC were observed in patients with low-normal renin, especially in autoimmune PAI (86 vs 65 μg/daily,
p
< 0.05). On the contrary, reduced sodium and increased potassium levels were observed in patients with high renin at T2. The number of cardiovascular events (15 in the whole cohort) was similar in patients sorted by renin levels or FC dose.
Conclusions
Renin and electrolytes can indicate the MC activity of FC treatment: they should be routinely evaluated and used to titrate its dose that can be reduced in the long-term follow-up.</description><identifier>ISSN: 1720-8386</identifier><identifier>ISSN: 0391-4097</identifier><identifier>EISSN: 1720-8386</identifier><identifier>DOI: 10.1007/s40618-022-01889-1</identifier><identifier>PMID: 35947299</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Addison Disease - drug therapy ; Adrenal Insufficiency - chemically induced ; Electrolytes ; Electrolytes - therapeutic use ; Endocrinology ; Fludrocortisone - therapeutic use ; Glucocorticoids ; Humans ; Internal Medicine ; Medicine ; Medicine & Public Health ; Metabolic Diseases ; Mineralocorticoids ; Original ; Original Article ; Patients ; Potassium ; Potassium - therapeutic use ; Renin ; Sodium</subject><ispartof>Journal of endocrinological investigation, 2023-01, Vol.46 (1), p.111-122</ispartof><rights>The Author(s) 2022</rights><rights>2022. The Author(s).</rights><rights>The Author(s) 2022. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c404t-6a70514d8fd3b110688dab8bf9e10b40b03877a45c9089f3c70f977877f9b7183</citedby><cites>FETCH-LOGICAL-c404t-6a70514d8fd3b110688dab8bf9e10b40b03877a45c9089f3c70f977877f9b7183</cites><orcidid>0000-0003-1526-6832 ; 0000-0003-4092-5107 ; 0000-0003-1456-8716 ; 0000-0001-9396-3815 ; 0000-0002-1081-5727 ; 0000-0002-8996-410X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s40618-022-01889-1$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s40618-022-01889-1$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35947299$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ceccato, F.</creatorcontrib><creatorcontrib>Torchio, M.</creatorcontrib><creatorcontrib>Tizianel, I.</creatorcontrib><creatorcontrib>Peleg Falb, M.</creatorcontrib><creatorcontrib>Barbot, M.</creatorcontrib><creatorcontrib>Sabbadin, C.</creatorcontrib><creatorcontrib>Betterle, C.</creatorcontrib><creatorcontrib>Scaroni, C.</creatorcontrib><title>Renin and electrolytes indicate the mineralocorticoid activity of fludrocortisone: a 6 year study in primary adrenal insufficiency</title><title>Journal of endocrinological investigation</title><addtitle>J Endocrinol Invest</addtitle><addtitle>J Endocrinol Invest</addtitle><description>Context
Fludrocortisone (FC) is the mineralocorticoid (MC) replacement treatment for patients with primary adrenal insufficiency (PAI).
Objective
To explore the dose of FC treatment and its relationship with glucocorticoid therapy, sodium, potassium, renin and clinical parameters.
Setting
Monocentric cohort.
Patients
Data of 193 patients with PAI (130 autoimmune) were collected during baseline (T0), intermediate (T1) and last follow-up visit (T2, respectively, after a mean of 38 and 72 months).
Main outcome measure
Utility of endocrine and clinical parameters to titrate FC dose.
Results
FC dose (50–75 μg/daily) was stable in the follow-up in half patients. The MC activity of FC was dose-dependent: we observed a reduced but significant positive linear correlation between FC dose and sodium (
r
= 0.132) and negative linear correlation between FC and potassium (
r
= − 0.162) or renin (
r
= − 0.131, all
p
< 0.01). An overall reduction in the FC dose was observed at T2 in the group with longer follow-up (> 60 months,
p
< 0.05). Higher doses of FC were observed in patients with low-normal renin, especially in autoimmune PAI (86 vs 65 μg/daily,
p
< 0.05). On the contrary, reduced sodium and increased potassium levels were observed in patients with high renin at T2. The number of cardiovascular events (15 in the whole cohort) was similar in patients sorted by renin levels or FC dose.
Conclusions
Renin and electrolytes can indicate the MC activity of FC treatment: they should be routinely evaluated and used to titrate its dose that can be reduced in the long-term follow-up.</description><subject>Addison Disease - drug therapy</subject><subject>Adrenal Insufficiency - chemically induced</subject><subject>Electrolytes</subject><subject>Electrolytes - therapeutic use</subject><subject>Endocrinology</subject><subject>Fludrocortisone - therapeutic use</subject><subject>Glucocorticoids</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Metabolic Diseases</subject><subject>Mineralocorticoids</subject><subject>Original</subject><subject>Original Article</subject><subject>Patients</subject><subject>Potassium</subject><subject>Potassium - therapeutic use</subject><subject>Renin</subject><subject>Sodium</subject><issn>1720-8386</issn><issn>0391-4097</issn><issn>1720-8386</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><recordid>eNp9kc1u1TAQhSMEoqXwAiyQJTZsAuM4iW0WSKjiT6qEhGBtOfa4dZVrF9uplDUvwrPwZPiSSyksWNmaOfPNHJ2meUzhOQXgL3IPIxUtdF0LVAjZ0jvNMeUdtIKJ8e6t_1HzIOdLAMaZ4PebIzbInndSHjffPmHwgehgCc5oSorzWjATH6w3uiApF0h2PmDSczQxFW-it0Sb4q99WUl0xM2LTVsvx4AviSbjj-8r6kRyWexaWeQq-Z1OK9E2YdBzLeXFOW88BrM-bO45PWd8dHhPmi9v33w-fd-efXz34fT1WWt66Es7ag4D7a1wlk2UwiiE1ZOYnEQKUw8TVHNc94ORIKRjhoOTnNeakxOngp00rzbu1TLt0BoMpbpSh9tU1F793Qn-Qp3HayVFJ8duqIBnB0CKXxfMRe18NjjPOmBcsuo4wMjkIPoqffqP9DIuqVrfq8ZOMjGIPbDbVCbFnBO6m2MoqH3GastY1YzVr4wVrUNPbtu4GfkdahWwTZBrK5xj-rP7P9if0JK2Bg</recordid><startdate>20230101</startdate><enddate>20230101</enddate><creator>Ceccato, F.</creator><creator>Torchio, M.</creator><creator>Tizianel, I.</creator><creator>Peleg Falb, M.</creator><creator>Barbot, M.</creator><creator>Sabbadin, C.</creator><creator>Betterle, C.</creator><creator>Scaroni, C.</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-1526-6832</orcidid><orcidid>https://orcid.org/0000-0003-4092-5107</orcidid><orcidid>https://orcid.org/0000-0003-1456-8716</orcidid><orcidid>https://orcid.org/0000-0001-9396-3815</orcidid><orcidid>https://orcid.org/0000-0002-1081-5727</orcidid><orcidid>https://orcid.org/0000-0002-8996-410X</orcidid></search><sort><creationdate>20230101</creationdate><title>Renin and electrolytes indicate the mineralocorticoid activity of fludrocortisone: a 6 year study in primary adrenal insufficiency</title><author>Ceccato, F. ; Torchio, M. ; Tizianel, I. ; Peleg Falb, M. ; Barbot, M. ; Sabbadin, C. ; Betterle, C. ; Scaroni, C.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c404t-6a70514d8fd3b110688dab8bf9e10b40b03877a45c9089f3c70f977877f9b7183</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Addison Disease - drug therapy</topic><topic>Adrenal Insufficiency - chemically induced</topic><topic>Electrolytes</topic><topic>Electrolytes - therapeutic use</topic><topic>Endocrinology</topic><topic>Fludrocortisone - therapeutic use</topic><topic>Glucocorticoids</topic><topic>Humans</topic><topic>Internal Medicine</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Metabolic Diseases</topic><topic>Mineralocorticoids</topic><topic>Original</topic><topic>Original Article</topic><topic>Patients</topic><topic>Potassium</topic><topic>Potassium - therapeutic use</topic><topic>Renin</topic><topic>Sodium</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ceccato, F.</creatorcontrib><creatorcontrib>Torchio, M.</creatorcontrib><creatorcontrib>Tizianel, I.</creatorcontrib><creatorcontrib>Peleg Falb, M.</creatorcontrib><creatorcontrib>Barbot, M.</creatorcontrib><creatorcontrib>Sabbadin, C.</creatorcontrib><creatorcontrib>Betterle, C.</creatorcontrib><creatorcontrib>Scaroni, C.</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of endocrinological investigation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ceccato, F.</au><au>Torchio, M.</au><au>Tizianel, I.</au><au>Peleg Falb, M.</au><au>Barbot, M.</au><au>Sabbadin, C.</au><au>Betterle, C.</au><au>Scaroni, C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Renin and electrolytes indicate the mineralocorticoid activity of fludrocortisone: a 6 year study in primary adrenal insufficiency</atitle><jtitle>Journal of endocrinological investigation</jtitle><stitle>J Endocrinol Invest</stitle><addtitle>J Endocrinol Invest</addtitle><date>2023-01-01</date><risdate>2023</risdate><volume>46</volume><issue>1</issue><spage>111</spage><epage>122</epage><pages>111-122</pages><issn>1720-8386</issn><issn>0391-4097</issn><eissn>1720-8386</eissn><abstract>Context
Fludrocortisone (FC) is the mineralocorticoid (MC) replacement treatment for patients with primary adrenal insufficiency (PAI).
Objective
To explore the dose of FC treatment and its relationship with glucocorticoid therapy, sodium, potassium, renin and clinical parameters.
Setting
Monocentric cohort.
Patients
Data of 193 patients with PAI (130 autoimmune) were collected during baseline (T0), intermediate (T1) and last follow-up visit (T2, respectively, after a mean of 38 and 72 months).
Main outcome measure
Utility of endocrine and clinical parameters to titrate FC dose.
Results
FC dose (50–75 μg/daily) was stable in the follow-up in half patients. The MC activity of FC was dose-dependent: we observed a reduced but significant positive linear correlation between FC dose and sodium (
r
= 0.132) and negative linear correlation between FC and potassium (
r
= − 0.162) or renin (
r
= − 0.131, all
p
< 0.01). An overall reduction in the FC dose was observed at T2 in the group with longer follow-up (> 60 months,
p
< 0.05). Higher doses of FC were observed in patients with low-normal renin, especially in autoimmune PAI (86 vs 65 μg/daily,
p
< 0.05). On the contrary, reduced sodium and increased potassium levels were observed in patients with high renin at T2. The number of cardiovascular events (15 in the whole cohort) was similar in patients sorted by renin levels or FC dose.
Conclusions
Renin and electrolytes can indicate the MC activity of FC treatment: they should be routinely evaluated and used to titrate its dose that can be reduced in the long-term follow-up.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>35947299</pmid><doi>10.1007/s40618-022-01889-1</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0003-1526-6832</orcidid><orcidid>https://orcid.org/0000-0003-4092-5107</orcidid><orcidid>https://orcid.org/0000-0003-1456-8716</orcidid><orcidid>https://orcid.org/0000-0001-9396-3815</orcidid><orcidid>https://orcid.org/0000-0002-1081-5727</orcidid><orcidid>https://orcid.org/0000-0002-8996-410X</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1720-8386 |
| ispartof | Journal of endocrinological investigation, 2023-01, Vol.46 (1), p.111-122 |
| issn | 1720-8386 0391-4097 1720-8386 |
| language | eng |
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| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Addison Disease - drug therapy Adrenal Insufficiency - chemically induced Electrolytes Electrolytes - therapeutic use Endocrinology Fludrocortisone - therapeutic use Glucocorticoids Humans Internal Medicine Medicine Medicine & Public Health Metabolic Diseases Mineralocorticoids Original Original Article Patients Potassium Potassium - therapeutic use Renin Sodium |
| title | Renin and electrolytes indicate the mineralocorticoid activity of fludrocortisone: a 6 year study in primary adrenal insufficiency |
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