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Background: As renin and aldosterone levels vary during the menstrual cycle, and are critical criteria for interpretation of aldosterone suppression tests to confirm or exclude primary aldosteronism, outcome of testing may vary depending on the menstrual cycle phase. We assessed the effect of timing within the menstrual cycle on levels of renin, aldosterone and female sex steroids during fludrocortisone suppression testing (FST)., Methods: In 22 women undergoing FST who experienced regular menstrual cycles, renin (measured as both plasma renin activity and direct renin concentration), aldosterone (mass spectrometry) and cortisol, progesterone, oestradiol, LH and FSH (immunoassay) levels were compared, relative to phase of cycle. Aldosterone levels were compared to those in age-matched males undergoing FST., Results: Progesterone (P < 0·0001) and aldosterone (P = 0·006) levels were higher in nine women (after one of 10 was excluded with anovulatory cycle) studied during the luteal phase than in the 12 studied during the follicular phase. All studied during the luteal phase had positive FST, and all three with negative FST were studied during the follicular phase. There were no significant differences in other parameters measured except FSH, which was higher (P = 0·02) during the follicular phase. Aldosterone was higher (P = 0·01) in women studied in the luteal (but not follicular) phase compared to men., Conclusion: The menstrual cycle may affect the outcome of FST and other suppression testing used to diagnose primary aldosteronism. Larger patient numbers and preferably restudy of the same patient in both phases should clarify this and determine the optimum time in the cycle for testing., (© 2014 John Wiley & Sons Ltd.)

Experimental and human data suggest that adverse cardiovascular (CV) and renal effects of aldosterone excess are dependent on concomitant dietary salt intake. Increased urinary protein (Uprot) is an early sign of nephropathy independently associated with CV risk. We have previously reported a positive association between Uprot and urinary sodium (UNa) in patients with hyperaldosteronism, but not in patients with normal aldosterone levels. We aimed to determine whether Uprot is related to UNa in patients with aldosterone-producing adenoma (APA) and whether the degree of Uprot and strength of this relationship is reduced following correction of hyperaldosteronism. Subjects with APA (n=24) underwent measurement of 24 h Uprot and UNa before and after unilateral adrenalectomy (follow-up 15.0±11.9 months). Following surgery, mean clinic systolic blood pressure fell (150.4±18.2 vs 134.5±14.5 mm Hg, P=0.0008), despite a reduction in number of antihypertensive medications, and Uprot (211.2±101.6 vs 106.0±41.8 mg per day, P<0.0001) decreased. There was a positive correlation between Uprot and UNa both before (r=0.5477, P=0.0056) and after (r=0.5097, P=0.0109) adrenalectomy. Changes in UNa independently predicted Uprot reduction (P=0.0189). These findings suggest that both aldosterone levels and dietary salt contribute to renal damage, and that once glomerular damage occurs it is not completely resolved following correction of hyperaldosteronism. Our study suggests that treatment strategies based on reduction of aldosterone effects, by adrenalectomy or mineralocorticoid receptor blockade, in conjunction with low-salt diet would provide additional target-organ protection in patients with primary aldosteronism.

Context: In 22 patients with unilateral primary aldosteronism (UPA), unilateral laparoscopic adrenalectomy (ADX) not only corrected hypokalemia and led to cure or improvement of hypertension, but also significantly improved quality of life (QOL)., Setting and Design: In this pilot study, QOL was evaluated prospectively using SF-36 questionnaire before and 3 and 6 months after ADX in 22 patients [14 males] with UPA who underwent ADX within the Endocrine Hypertension Research Center, Greenslopes and Princess Alexandra Hospitals, between June 2007 and June 2008., Results: Eighty-six percent of patients were cured of hypertension, and the remainder improved. Plasma potassium normalized and, whereas renin concentration increased, plasma aldosterone, aldosterone/renin ratio, and number of antihypertensive agents decreased. Preoperatively, SF-36 scores for each QOL domain were lower for UPA patients than reported for the Australian general population, especially for physical functioning, role physical, vitality, and general health. Significant improvements were seen at 3 months in physical functioning, role physical, social functioning, role emotional, general health, mental health, and vitality and at 6 months in physical functioning, role physical, general health, role emotional, mental health, and vitality., Conclusion: Unilateral adrenalectomy had positive impacts not only on blood pressure and biochemical parameters, but also on QOL, which was impaired preoperatively but significantly improved by 3 months postoperatively.