Management of hypertension and heart failure in patients with Addison's disease

  title={Management of hypertension and heart failure in patients with Addison's disease},
  author={Warrick J. Inder and Caroline Meyer and Penny J. Hunt},
  journal={Clinical Endocrinology},
Addison's disease may be complicated by hypertension and less commonly by heart failure. We review the pathophysiology of the renin‐angiotensin‐aldosterone axis in Addison's disease and how this is altered in the setting of hypertension and heart failure. An essential first step in management in both conditions is optimizing glucocorticoid replacement and considering dose reduction if excessive. Following this, if a patient with Addison's disease remains hypertensive, the fludrocortisone dose… 

Identifying a disease-specific renin-angiotensin-aldosterone system fingerprint in patients with primary adrenal insufficiency.

AI is associated with a unique RAAS profile characterized by the absence of aldosterone despite strongly elevated levels of angiotensin metabolites, including the potent vasoconstrictor AngII.

Plasma renin levels are associated with cardiac function in primary adrenal insufficiency

Higher renin concentrations are associated with more favorable cardiac function and morphology in patients with primary AI.

Primary Adrenal Insufficiency: Managing Mineralocorticoid Replacement Therapy

The commonly used MC replacement in PAI may not be adequate in some patients, and insufficient MC substitution may be responsible for poor cardiometabolic outcome and the failure to restore well-being adequately in patients with PAI.

Adrenal insufficiency

Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline.

A low diagnostic threshold in acutely ill patients, as well as in patients with predisposing factors, is suggested for pregnant women with unexplained persistent nausea, fatigue, and hypotension and a short corticotropin test is recommended as the "gold standard" diagnostic tool to establish the diagnosis.

Perspective of pharmaceutical practice in adrenal insufficiency: An integrative review

It is established that the AI patient follow-up must be performed regularly by a multidisciplinary team and the identification of health measures that a pharmacist integrated with the healthcare team should perform is identified.

Transsphenoidal pituitary adenoma resection: do early post-operative cortisol levels predict permanent long-term hypocortisolism?

Postoperative early morning cortisol levels seem to be less sensitive and specific in predicting long-term corticotroph function than measurements after 6 weeks and 1 year, emphasizing the importance of endocrine follow-up testing.

Transsphenoidal Pituitary Adenoma Resection: Do Early Post-Operative Cortisol Levels Predict Permanent Long-Term Hormone Deficiency?

Postoperative early morning cortisol levels seem to be less sensitive and specific in predicting long-term hormone deficiency than measurements after 6 weeks and 1 year, emphasizing the importance of endocrine follow-up testing.

Treg cells depletion is a mechanism that drives microvascular dysfunction in mice with established hypertension.

Oral Manifestations of Systemic Diseases and Their Treatments

This chapter will address the impact of key selected systemic diseases and/or systemic treatment on oral tissues, including those caused by cancer therapies and as well as medications that result in salivary compromise.



Cardiac failure in Addison's disease.

Atrial natriuretic peptide and plasma renin levels in assessment of mineralocorticoid replacement in Addison's disease.

Evaluated plasma atrial natriuretic peptide measurements as a marker of sodium and volume status in Addison's disease suggest that PRC is of value in determining mineralocorticoid underreplacement, whereas ANP is a more sensitive index of FC overreplacement.

BNP in hormone-guided treatment of heart failure

Mineralocorticoids in the management of primary adrenocortical insufficiency

Plasma renin activity (PRA) and plasma volume (PV) were determined in 22 adult patients treated for Addison’s disease (AD) and reporting at the clinic for follow-up, and there was an inverse relationship between PRA and PV.

The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators.

Blockade of aldosterone receptors by spironolactone, in addition to standard therapy, substantially reduces the risk of both morbidity and death among patients with severe heart failure.

Additional use of an aldosterone antagonist in patients with mild to moderate chronic heart failure: a systematic review and meta‐analysis

The evidence for the efficacy of spironolactone (SP), eplerenone (EP) and canrenone in mild to moderate CHF patients is summarized.

Aldosterone and cardiovascular disease: the heart of the matter

Consensus statement on the diagnosis, treatment and follow‐up of patients with primary adrenal insufficiency

A European Expert Consensus Statement for diagnosis, treatment and follow‐up ofPrimary adrenal insufficiency is attempted to provide a guide for the treatment and detection of new autoimmune diseases.

Cardiovascular Risk Factors in Patients with Addison's Disease: A Comparative Study of South African and Swedish Patients

South African patients with AD have worse lipid profiles and higher hs-CRP compared to their matched Swedish patients, despite lower doses of hydrocortisone, according to a cross-sectional study.