ISSN 2415-3060 (print), ISSN 2522-4972 (online)
  • 15 of 32
Up
JMBS 2022, 7(6): 100–108
https://doi.org/10.26693/jmbs07.06.100
Clinical Medicine

Assessment of the State of the Renin-Angiotensin-Aldosterone System in the Early Diagnosis of Hormonally Active Tumors of the Adrenal Cortex Layer

Roienko Yu. V.
Abstract

The purpose of the study was to determine the markers of the state of the renin-angiotensin-aldosterone system in patients with hormonally active tumors of the adrenal cortex layer as predictors of the choice of surgical intervention tactics. Materials and methods. The results of analyzes of clinical and laboratory research of 38 patients with tumors of the adrenal glands in the conditions of the department of endocrine surgery were analyzed. Depending on the type of hormonally active adrenocortical adenoma, all patients were divided into three groups: group I – patients who developed aldosteromas; group II – patients with corticosteromas; group III – patients with corticoaldosteromas. Results and discussion. As a result of research, it was found that the development of hormonally active adrenocortical adenomas in the body is accompanied by an increase in the blood plasma of the concentration of the main adrenal hormones: mineralocorticoid – aldosterone and glucocorticoid – cortisol. These changes are accompanied by dysfunction of the renin-angiotensin-aldosterone system, which is most pronounced in patients with aldosteromas and corticoaldosteromas, which is expressed by an increase in the aldosterone/renin ratio. At the same time, in patients with corticosteromas, as well as with corticoaldosteromas, hormonal imbalance is expressed by an increase in the level of adrenocorticotropic hormone in the blood serum. Hypernatremia and hypokalemia found in patients with corticosteromas may be due to some mineralocorticoid activity of cortisol, which is manifested when it is in excess in the body. In this group of patients, arterial hypertension may also be observed, although it may be less pronounced. Therefore, in order to maintain a normal level of sodium and potassium and prevent an increase in blood pressure, it is necessary to simultaneously determine the concentration of aldosterone, cortisol and renin in the blood, since the functioning of these biologically active substances are closely interconnected. Thus, the determination of the level of aldosterone and cortisol in the blood plasma of patients with hormonally active adrenocortical adenomas serves as a marker for the early diagnosis of the type of hormonally active tumors, the detection of which, along with the study of the renin-angiotensin system and the level of adrenocorticotropic hormone, makes it possible to predict the direction of water-salt exchange in the body Timely establishment of these changes will prevent the risk of developing complications from other organs and systems (cardiovascular, urinary, nervous). Conclusion. It was established that the imbalance of the renin-angiotensin-aldosterone system and the pituitary-adrenal system contributes to the violation of the water-electrolyte balance, which is expressed by hypernatremia and hypokalemia and is most pronounced in patients with a mixed type of adrenocortical adenoma

Keywords: adrenocortical adenoma, aldosterone, cortisol, renin, adrenocorticotropic hormone

Full text: PDF (Ukr) 314K

References
  1. Ono Y, Nakamura Y, Maekawa T, Felizola SJ, Morimoto R, Iwakura Y, et al. Different expression of 11beta-hydroxylase and aldosterone synthase between aldosterone-producing microadenomas and macroadenomas. Hypertension. 2014 Aug;64(2):438-44. PMID: 24842915. PMCID: PMC5478923. doi: 10.1161/HYPERTENSIONAHA.113.02944
  2. Debono M, Bradburn M, Bull M, Harrison B, Ross RJ, Newell-Price J. Cortisol as a marker for increased mortality in patients with incidental adrenocortical adenomas. J Clin Endocrinol Metab. 2014 Dec;99(12):4462-70. PMID: 25238207. PMCID: PMC4255126. doi: 10.1210/jc.2014-3007
  3. Lee DY, Kim E, Choi MH. Technical and clinical aspects of cortisol as a biochemical marker of chronic stress. BMB Rep. 2015 Apr;48(4):209-16. PMID: 25560699. PMCID: PMC4436856. doi: 10.5483/BMBRep.2015.48.4.275
  4. Lee FT, Elaraj D. Evaluation and management of primary hyperaldosteronism. Surg Clin North Am. 2019 Aug;99(4):731-745. PMID: 31255203. doi: 10.1016/j.suc.2019.04.010
  5. Hodgson A, Pakbaz S, Mete O. A diagnostic approach to adrenocortical tumors. Surg Pathol Clin. 2019 Dec;12(4):967-995. PMID: 31672302. doi: 10.1016/j.path.2019.08.005
  6. Faillot S, Assie G. Endocrine tumours: The genomics of adrenocortical tumors. Eur J Endocrinol. 2016 Jun;174(6):R249-65. PMID: 26739091. doi: 10.1530/EJE-15-1118
  7. Vilela LAP, Almeida MQ. Diagnosis and management of primary aldosteronism. Arch Endocrinol Metab. 2017 May-Jun;61(3):305-312. PMID: 28699986. doi: 10.1590/2359-3997000000274
  8. Hellman P, Björklund P, Аkerström T. Aldosterone-producing adenomas. Vitam Horm. 2019;109:407-431. PMID: 30678866. doi: 10.1016/bs.vh.2018.10.007
  9. Bhatt PS, Sam AH, Meeran KM, Salem V. The relevance of cortisol co-secretion from aldosterone-producing adenomas. Hormones (Athens). 2019 Sep;18(3):307-313. PMID: 31399957. PMCID: PMC6797639. doi: 10.1007/s42000-019-00114-8
  10. Ames MK, Atkins CE, Pitt B. The renin-angiotensin-aldosterone system and its suppression. J Vet Intern Med. 2019 Mar;33(2):363-382. PMID: 30806496. PMCID: PMC6430926. doi: 10.1111/jvim.15454
  11. Lightman SL, Birnie MT, Conway-Campbell BL. Dynamics of ACTH and cortisol secretion and implications for disease. Endocr Rev. 2020 Jun 1;41(3):470-90. PMID: 32060528. PMCID: PMC7240781. doi: 10.1210/endrev/bnaa002
  12. Murakami M, Rhayem Y, Kunzke T, Sun N, Feuchtinger A, Ludwig P, et al. In situ metabolomics of aldosterone-producing adenomas. JCI Insight. 2019 Sep 5;4(17):e130356. PMID: 31484828. PMCID: PMC6777904. doi: 10.1172/jci.insight.130356
  13. Kawarazaki W, Fujita T. The role of aldosterone in obesity-related hypertension. Am J Hypertens. 2016 Apr;29(4):415-23. PMID: 26927805. PMCID: PMC4886496. doi: 10.1093/ajh/hpw003
  14. Wilkinson-Berka JL, Suphapimol V, Jerome JR, Deliyanti D, Allingham MJ. Angiotensin II and aldosterone in retinal vasculopathy and inflammation. Exp Eye Res. 2019 Oct;187:107766. PMID: 31425690. doi: 10.1016/j.exer.2019.107766
  15. Miller BS, Auchus RJ. Evaluation and treatment of patients with hypercortisolism: a review. JAMA Surg. 2020 Dec 1;155(12):1152-1159. PMID: 33052413. doi: 10.1001/jamasurg.2020.3280
  16. Riek A, Schrader L, Zerbe F, Petow S. Comparison of cortisol concentrations in plasma and saliva in dairy cattle following ACTH stimulation. J Dairy Res. 2019 Nov;86(4):406-409. PMID: 31722772. doi: 10.1017/S0022029919000669
  17. Fan L, Zhuang Y, Wang Y, Liu X, Liu D, Xiang B, He M, et al. Association of hypokalemia with cortisol and ACTH levels in Cushing's disease. Ann N Y Acad Sci. 2020 Mar;1463(1):60-66. PMID: 31456238. doi: 10.1111/nyas.14205
  18. Oki K, Gomez-Sanchez CE. The landscape of molecular mechanism for aldosterone production in aldosterone-producing adenoma. Endocr J. 2020 Oct 28;67(10):989-995. PMID: 32968034. PMCID: PMC9044104. doi: 10.1507/endocrj.EJ20-0478
  19. Shimada H, Yamazaki Y, Sugawara A, Sasano H, Nakamura Y. Molecular mechanisms of functional adrenocortical adenoma and carcinoma: genetic characterization and intracellular signaling pathway. Biomedicines. 2021 Jul 26;9(8):892. PMID: 34440096. PMCID: PMC8389593. doi: 10.3390/biomedicines9080892