Classic and nonclassic apparent mineralocorticoid excess syndrome

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dc.catalogadorvzp
dc.contributor.authorCarvajal, Cristián A.
dc.contributor.authorTapia-Castillo, Alejandra
dc.contributor.authorVecchiola, Andrea
dc.contributor.authorBaudrand, Rene
dc.contributor.authorFardella, Carlos
dc.date.accessioned2024-05-30T20:33:29Z
dc.date.available2024-05-30T20:33:29Z
dc.date.issued2020
dc.description.abstract© 2020 Endocrine Society. All rights reserved.Context: Arterial hypertension (AHT) is one of the most frequent pathologies in the general population. Subtypes of essential hypertension characterized by low renin levels allowed the identification of 2 different clinical entities: aldosterone-mediated mineralocorticoid receptor (MR) activation and cortisol-mediated MR activation. Evidence Acquisition: This review is based upon a search of Pubmed and Google Scholar databases, up to August 2019, for all publications relating to endocrine hypertension, apparent mineralocorticoid excess (AME) and cortisol (F) to cortisone (E) metabolism. Evidence Synthesis: The spectrum of cortisol-mediated MR activation includes the classic AME syndrome to milder (nonclassic) forms of AME, the latter with a much higher prevalence (7.1%) than classic AME but different phenotype and genotype. Nonclassic AME (NC-AME) is mainly related to partial 11βHSD2 deficiency associated with genetic variations and epigenetic modifications (first hit) and potential additive actions of endogenous or exogenous inhibitors (ie, glycyrrhetinic acid-like factors [GALFS]) and other factors (ie, age, high sodium intake) (second hit). Subjects with NC-AME are characterized by a high F/E ratio, low E levels, normal to elevated blood pressure, low plasma renin and increased urinary potassium excretion. NCAME condition should benefit from low-sodium and potassium diet recommendations and monotherapy with MR antagonists. Conclusion: NC-AME has a higher prevalence and a milder phenotypical spectrum than AME. NC-AME etiology is associated to a first hit (gene and epigene level) and an additive second hit. NC-AME subjects are candidates to be treated with MR antagonists aimed to improve blood pressure, end-organ damage, and modulate the renin levels.
dc.fuente.origenScopus
dc.identifier.doi10.1210/clinem/dgz315
dc.identifier.eissn19457197
dc.identifier.issn19457197 0021972X
dc.identifier.pubmedid31909799
dc.identifier.scopusidSCOPUS_ID:85081945131
dc.identifier.urihttps://academic.oup.com/jcem
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/86110
dc.identifier.wosidWOS:000525950100135
dc.language.isoen
dc.nota.accesocontenido parcial
dc.pagina.finalE936
dc.pagina.inicioE924
dc.publisherEndocrine Society
dc.revistaJournal of Clinical Endocrinology and Metabolism
dc.rightsacceso restringido
dc.subjectAME
dc.subjectArterial hypertension
dc.subjectLow renin
dc.subjectMetabolic
dc.subjectNonclassic AME
dc.subject.ddc610
dc.subject.deweyMedicina y saludes_ES
dc.titleClassic and nonclassic apparent mineralocorticoid excess syndrome
dc.typeartículo
dc.volumen105
sipa.trazabilidadScopus;12-10-2021
sipa.trazabilidadORCID;2024-05-27
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