血浆肾素血浆肾素:原发性肾上腺功能不全患者调整矿质皮质激素的有用指标

IF 3 Q2 ENDOCRINOLOGY & METABOLISM Journal of the Endocrine Society Pub Date : 2024-10-11 eCollection Date: 2024-09-26 DOI:10.1210/jendso/bvae174
Cécilia Piazzola, Bleunn Dreves, Frédérique Albarel, Jérémie Nakache, Julia Morera, Michaël Joubert, Thierry Brue, Yves Reznik, Frédéric Castinetti
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As supraphysiological hydrocortisone might have additional MC activity, we integrated the individual hydrocortisone dose to obtain the MC equivalent dose (Eq-MC). Renin less than 20 mIU/L was considered oversubstituted, renin between 20 and 60 mIU/L as correctly substituted, and renin over 60 mIU/L as undersubstituted.</p><p><strong>Results: </strong>The mean dose of fludrocortisone was 82.3 ± 46 μg/day. Plasma renin was abnormal in 56.7% of cases (7 patients oversubstituted and 78 patients undersubstituted). Abnormalities in electrolyte levels were observed in only 12.7% of patients. Plasma renin correlated negatively with sodium (<i>P</i> < .01) and systolic blood pressure (<i>P</i> = .026), and positively with potassium (<i>P</i> < .01). 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引用次数: 0

摘要

背景:肾素是血容量的标志物。关于原发性肾上腺功能不全(PAI)患者使用血浆肾素来调整矿质皮质激素(MC)替代物的有效性,目前尚未达成共识:本研究旨在探讨血浆肾素是否可用于调整PAI患者的MC替代量:方法:回顾性纳入2008年至2022年期间在2个三级专家中心随访的150名至少测量过一次血浆肾素的PAI患者。由于超生理水平的氢化可的松可能具有额外的MC活性,我们整合了单个氢化可的松剂量以获得MC当量剂量(Eq-MC)。低于 20 mIU/L 的肾素被视为替代过量,介于 20 至 60 mIU/L 之间的肾素被视为替代正确,而超过 60 mIU/L 的肾素则被视为替代不足:氟氢可的松的平均剂量为 82.3 ± 46 μg/天。56.7%的病例血浆肾素异常(7 名患者肾素过量,78 名患者肾素不足)。只有 12.7% 的患者出现电解质水平异常。血浆肾素与钠 (P < .01) 和收缩压 (P = .026) 呈负相关,与钾 (P < .01) 呈正相关。Eq-MC剂量的变化对肾素水平有显著的统计学影响(P = .0037),MC剂量的增加与肾素水平的降低相关,反之亦然;电解质或血压没有观察到相关性:结论:血浆肾素与电解质和血压相关。结论:血浆肾素与电解质和血压相关,剂量变化会明显改变肾素水平,而电解质和血压不会,这表明肾素可能比电解质和血压更能提供有关 MC 替代治疗的信息。
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Plasma Renin: A Useful Marker for Mineralocorticoid Adjustment in Patients With Primary Adrenal Insufficiency.

Context: Renin is a marker of blood volume. There is no consensus on the validity of plasma renin measurement for adjusting mineralocorticoid (MC) substitution in patients with primary adrenal insufficiency (PAI).

Objective: This work aimed to investigate if plasma renin could be used to adjust MC substitution in patients with PAI.

Methods: A total of 150 patients with at least one measurement of plasma renin followed for PAI at 2 tertiary expert centers between 2008 and 2022 were retrospectively included. As supraphysiological hydrocortisone might have additional MC activity, we integrated the individual hydrocortisone dose to obtain the MC equivalent dose (Eq-MC). Renin less than 20 mIU/L was considered oversubstituted, renin between 20 and 60 mIU/L as correctly substituted, and renin over 60 mIU/L as undersubstituted.

Results: The mean dose of fludrocortisone was 82.3 ± 46 μg/day. Plasma renin was abnormal in 56.7% of cases (7 patients oversubstituted and 78 patients undersubstituted). Abnormalities in electrolyte levels were observed in only 12.7% of patients. Plasma renin correlated negatively with sodium (P < .01) and systolic blood pressure (P = .026), and positively with potassium (P < .01). Doses changes in Eq-MC had a statistically significant effect on renin levels (P = .0037), with an increase of MC dose correlating with a decrease in renin level and vice versa; no correlation was observed using electrolytes or blood pressure.

Conclusion: Plasma renin correlates with electrolytes and blood pressure. While dose changes significantly alter renin levels, electrolytes and blood pressure do not, suggesting that renin may provide more information about MC replacement therapy than electrolytes and blood pressure.

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来源期刊
Journal of the Endocrine Society
Journal of the Endocrine Society Medicine-Endocrinology, Diabetes and Metabolism
CiteScore
5.50
自引率
0.00%
发文量
2039
审稿时长
9 weeks
期刊最新文献
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