Moderators of the psychotropic effect of aldosterone in primary aldosteronism

Introduction:

Hyperaldosteronism appears to be related to depressive and anxiety related behavior as demonstrated patients therapy refractory depression and primary aldosteronism (PA).

Methods:

We analyzed data from the German's Conn register in order to clarify mediators and moderators of this influence. All patients received a standardized medication to ensure that the renin-angiotensin-aldosterone-system (RAAS) was not influenced. Up to 594 subjects were analyzed, however not all subjects had a complete dataset.

Results:

Men and women showed similar aldosterone concentrations and aldosterone/renin ratios (ARR) (p > 0.2), but women showed significantly higher renin levels (33.8 vs. 12.6 ng/ml, p < 0.05). Systolic and diastolic blood pressure was significantly higher in male vs. female subject (e.g. systolic blood pressure: 148.0 vs. 143.1 mmHg). Body size, waist circumference and BMI were significantly larger in male vs. female subjects as were signs of metabolic syndrome, including plasma glucose and triglycerides. The ratio of plasma sodium/potassium was significantly higher in males vs. females, pointing to a higher peripheral MR sensitivity in males. For further analysis we therefore split the groups according to gender and compared parameters for higher (PHQ-9 ≥5) vs. lower expressed depressive symptomatology. 56% of male and 61% of female subjects met this depression criterion. Depressive symptoms in male and in female subjects were significantly related to BMI (male: dep vs. non-dep: 29.6 vs. 28.4, p < 0.05; female: 26.9 vs. 24.5) and body weight (P < 0.05). In the total group ARR was by trend (p < 0.1) and in the female groups significantly correlated to depressiveness (dep vs. non-dep: 161.5 vs. 50.8). Neither blood pressure nor electrolytes were different between depression groups. The relationship of these parameters to anxiety was less pronounced and partially unexpected: only in male subjects higher anxiety (GAD ≥5) was related to lower systolic blood pressure.

Conclusion:

Significant biological gender differences occur in subject with PA. BMI appears to be a strong and independent correlated of higher depressive symptoms in patients with PA, independent of gender.