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Pathophysiological functions of adrenomedullin and natriuretic peptides in patients with primary aldosteronism

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Abstract

To measure the plasma concentrations of adrenomedullin (ADM),atrial natriuretic peptide (ANP), and brain natriuretic peptide (BNP), and investigate their pathophysiological functions in patients with primary aldosteronism (PA). Between June 2006 and December 2012, we recruited 25 patients with untreated PA, 30 patients with untreated low-renin essential hypertension (EH), and 35 healthy control subjects. The plasma concentrations of ADM, ANP, and BNP were measured in all the subjects. After 4 weeks of effective antihypertensive therapy with slow-release nifedipine, the three peptides were measured again in the PA and low-renin EH subjects. Unilateral laparoscopic adrenalectomy was performed in all the PA patients; 2 weeks after surgery, the three peptides were measured again. The PA patients had significantly higher plasma concentrations of ADM, ANP, and BNP than the low-renin EH and control subjects. The low-renin EH and control subjects significantly differed in the concentrations of the three peptides between low-renin EH and control subjects. ADM was the most important peptide associated with aldosterone or blood pressure in the PA patients. Plasma ADM concentration was not only correlated with plasma aldosterone concentrations, but also with systolic and diastolic blood pressures, and plasma ANP and BNP concentrations in the PA patients. By contrast, ADM concentration was not related to blood urea nitrogen levels, serum creatinine levels, and glomerular filtration rates. After antihypertensive treatment, the concentrations of the three peptides significantly decreased in the low-renin EH patients, but remained unchanged in the PA subjects. However, these concentrations significantly decreased 2 weeks after laparoscopic adrenalectomy in the PA subjects. ADM, ANP, and BNP possibly participate in the mechanisms counteracting further elevation of blood pressure or plasma volume expansion resulting from aldosterone hypersecretion in PA patients. An ADM/aldosterone local regulatory mechanism may be involved in regulating adrenal adenoma functions.

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Acknowledgments

This work has been approved by the Ethics Committee of Renmin Hospital Wuhan University. The authors would like to thank to the Department of Urology in Renmin Hospital of Wuhan University.

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Authors and Affiliations

  1. Department of Urology, Renmin Hospital of Wuhan University, 238# Liberation Road, Wuhan, 430060, Hubei Province, China

    Wei Hu, Xiao-bin Zhang, Chang-geng Xu & Wei Wang

  2. Department of Orthopaedics, Renmin Hospital of Wuhan University, 238# Liberation Road, Wuhan, 430060, Hubei Province, China

    Pang-hu Zhou

Authors
  1. Wei Hu
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  2. Pang-hu Zhou
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  3. Xiao-bin Zhang
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  4. Chang-geng Xu
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  5. Wei Wang
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Corresponding author

Correspondence to Xiao-bin Zhang.

Additional information

Wei Hu and Pang-hu Zhou have contributed equally to this study.

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Hu, W., Zhou, Ph., Zhang, Xb. et al. Pathophysiological functions of adrenomedullin and natriuretic peptides in patients with primary aldosteronism. Endocrine 48, 661–668 (2015). https://doi.org/10.1007/s12020-014-0316-9

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  • DOI: https://doi.org/10.1007/s12020-014-0316-9

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