1,721,102 research outputs found
EFFECTS OF FEMALE SEX HORMONES AND CONTRACEPTIVE PILL ON THE DIAGNOSTIC WORK-UP FOR PRIMARY ALDOSTERONISM
No full textThe present work highlights for the first time variations
with menstrual cycle or estroprogestin pill of newly discovered, or never related, urinary
proteins. In particular, possible protein markers could be useful for further applications in
contraceptive target research and RAAS modulation-related topics
Comment on 'Munchausen syndrome: a novel cause of drug-resistant hypertension'.
No full textcase report on 'Munchausen syndrome: a novel cause of drug-resistant hypertension'
Aldosterone to Renin Ratio (ARR) in Clinical use, with Reference to the Primary Care Setting: ARR to Whom, When, How, What for?
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Extensive life-treatening thrombosis in a patient with heparin-induced thrombocytopenia and factor V Leiden mutation
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Adrenalectomy Versus Medical Therapy in Primary Aldosteronism: A Meta-Analysis of Long-Term Cardiac Remodeling and Function: Medical Versus Adrenalectomy Treatment Compared in Hyperaldosteronism (MATCH) Study
No full textBackground: Primary aldosteronism (PA) is a common curable cause of secondary hypertension that significantly increases left ventricular mass (LVM) and predisposes patients to adverse cardiovascular outcomes. Although adrenalectomy and medical therapy with mineralocorticoid receptor antagonists (MRAs) are both used to treat PA, their long-term comparative efficacy in reversing cardiac structural changes remains debated. Methods: We systematically searched MEDLINE and Embase for prospective and retrospective clinical trials published up to November 22, 2024, with a minimum follow-up of 6 months that reported changes in LVM in patients with PA treated with adrenalectomy or MRAs. Data were independently extracted by 2 reviewers, and risk-of-bias assessments were conducted using standardized tools. The primary outcome was the percentage reduction in indexed LVM; secondary outcomes included changes in cardiac remodeling, and systolic and diastolic function parameters. Results: Seventeen studies comprising 1696 patients (49% adrenalectomy, 51% MRA therapy) were analyzed. Adrenalectomy yielded a significantly greater indexed LVM reduction (mean difference, -3.5% [95% CI, -4.9% to -2.2%]; P<0.0001) and a 32% reduction in left ventricular hypertrophy risk ratio, compared with a 19% reduction with MRAs. Meta-regression revealed that shorter hypertension duration predicted greater LVM regression following adrenalectomy, whereas high dietary sodium attenuated MRA effects. In addition, left ventricular ejection fraction improved modestly after adrenalectomy. Conclusions: Adrenalectomy provides superior long-term regression of LVM and left ventricular hypertrophy compared with MRAs in PA, supporting its use as the first-line treatment for unilateral PA. Future research should compare emerging nonsteroidal MRAs and aldosterone synthase inhibitors to further optimize cardiac remodeling outcomes
Vitamins and epigenetics
No full textThis chapter focuses on the role of vitamins with a recognized function in modulating epigenetic mechanisms. Epigenetics refers to the complex of somatically heritable states that regulate gene expression resulting from modifications in DNA and chromatin structure that occur without alterations in the DNA sequence. Epigenetic phenomena include DNA methylation, posttranslational histone modifications, chromatin remodeling mechanisms, and the role of small noncoding RNA. Folate, namely vitamin B9, is a major player in the link between vitamins and epigenetics because it is responsible for the transport of methyl groups for the methylation of DNA, one of the most significant epigenetic phenomena. While pathologic conditions are associated with severe vitamin deficiency, it is now known that even mild vitamin deficiencies, especially of the hydrosoluble B group, are related to the impairment of epigenetic features of DNA. Vitamin A status is also associated with the modification of DNA methylation and other epigenetic phenomena at histone tails sites
Laboratory diagnosis of primary aldosteronism, and drospirenone-ethinylestradiol therapy
No full textBACKGROUND: Primary aldosteronism is recognized as the most frequent cause of secondary hypertension. Screening for primary aldosteronism by determination of the aldosterone-to-renin ratio (ARR) is much more frequently performed in current practice. However, most antihypertensive medications interfere with ARR determination, and although verapamil and alpha-adrenergic blockers are considered sufficiently neutral, the specific drugs which should be discontinued before ARR screening are a matter of debate. Our objective was to evaluate the possible interference of a new progestin with antimineralocorticoid activity (drospirenone) on the determination of ARR and the diagnosis of primary aldosteronism.
METHODS AND RESULTS: We describe an instance of a false-positive laboratory diagnosis of primary aldosteronism (by both screening and confirmatory test) in a normotensive 34-year-old healthy woman taking Yasmin (drospirenone + ethinylestradiol) (Shering S.p.A., Milan, Italy). Subsequent ARR values during Yasmin therapy changed during the menstrual cycle (days 7, 14, 21, and 28 were tested), reaching values above the screening ARR threshold that led to a suspicion of primary aldosteronism just before menses. In contrast, during a drug-free menstrual cycle, the ARR remained constantly below the screening ARR threshold.
CONCLUSIONS: We report for the first time that drospirenone may interfere with laboratory screening and confirmatory testing for the diagnosis of primary aldosteronism. As a consequence, this drug should be withdrawn in hypertensive women investigated for secondary hypertension. Although drospirenone was demonstrated to possess antihypertensive properties when taken as postmenopausal hormonal replacement therapy, its use for contraceptive purposes needs to be more carefully investigated
Serum cystein versus creatinine:which value in the diagnostic work-up for renovascular disease
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