Optimization of left adrenal vein sampling in primary aldosteronism: Coping with asymmetrical cortisol secretion.

We evaluated the influence of catheter sampling position and size on left adrenal venous sampling (AVS) in patients with primary aldosteronism (PA) and analyzed their relationship to cortisol secretion. This retrospective study included 111 patients with a diagnosis of primary aldosteronism who underwent tetracosactide-stimulated AVS. Left AVS was obtained from two catheter positions - the central adrenal vein (CAV) and the common trunk. For common trunk sampling, 5-French catheters were used in 51 patients, and microcatheters were used in 60 patients. Autonomous cortisol secretion was evaluated with a low-dose dexamethasone suppression test in 87 patients. The adrenal/inferior vena cava cortisol concentration ratio [selectivity index (SI)] was significantly lower in samples from the left common trunk than those of the left CAV and right adrenal veins, but this difference was reduced when a microcatheter was used for common trunk sampling. Sample dilution in the common trunk of the left adrenal vein can be decreased by limiting sampling speed with the use of a microcatheter. Meanwhile, there was no significant difference in SI between the left CAV and right adrenal veins. Laterality, determined according to aldosterone/cortisol ratio (A/C ratio) based criteria, showed good reproducibility regardless of sampling position, unlike the absolute aldosterone value based criteria. However, in 11 cases with autonomous cortisol co-secretion, the cortisol hypersecreting side tended to be underestimated when using A/C ratio based criteria. Left CAV sampling enables symmetrical sampling, and may be essential when using absolute aldosterone value based criteria in cases where symmetrical cortisol secretion is uncertain.

Decreased hydrocortisone sensitivity of T cell function in multiple sclerosis-associated major depression.

Multiple sclerosis (MS) is an inflammatory, demyelinating disease of the CNS with a high prevalence of depression. Both MS and depression have been linked to elevated cortisol levels and inflammation, indicating disturbed endocrine-immune regulation. An imbalance in mineralocorticoid versus glucocorticoid signaling in the CNS has been proposed as a pathogenetic mechanism of depression. Intriguingly, both receptors are also expressed in lymphocytes, but their role for 'escape' of the immune system from endocrine control is unknown. Using steroid sensitivity of T cell function as a read-out system, we here investigate a potential role of mineralocorticoid receptor (MR) versus glucocorticoid receptor (GR) regulation in the immune system as a biological mechanism underlying MS-associated major depression. Twelve female MS patients meeting diagnostic criteria for current major depressive disorder (MDD) were compared to twelve carefully matched MS patients without depression. We performed lymphocyte phenotyping by flow cytometry. In addition, steroid sensitivity of T cell proliferation was tested using hydrocortisone as well as MR (aldosterone) and GR (dexamethasone) agonists. Sensitivity to hydrocortisone was decreased in T cells from depressed MS patients. Experiments with agonists suggested disturbed MR regulation, but intact GR function. Importantly, there were no differences in lymphocyte composition and frequency of T cell subsets, indicating that the differences in steroid sensitivity are unlikely to be secondary to shifts in the immune compartment. To our knowledge, this study provides first evidence for altered steroid sensitivity of T cells from MS patients with comorbid MDD possibly due to MR dysregulation.

Recurrent exacerbations of protein-losing enteropathy after initiation of growth hormone therapy in a Fontan patient controlled with spironolactone.

Protein-losing enteropathy (PLE) is a rare, but serious complication in single ventricle patients after Fontan palliation, and is associated with a 5-year mortality of 46%. We describe a patient with PLE after Fontan palliation who achieved remission with high-dose spironolactone (an aldosterone antagonist), but had three exacerbations each temporally correlated with the use of growth hormone (an aldosterone agonist). Because of the opposing mechanisms of action of these two medications, caution might be indicated when using growth hormone for patients with PLE who are successfully treated with spironolactone.

The Janus effect: two faces of aldosterone.

Inhibition of the nitric oxide pathway by N(omega)-nitro-l-arginine methyl ester (l-NAME) is well known to produce hypertension and proteinuria, but the mechanisms are less straightforward. Prolonged administration of mineralocorticoids mimics the pathological findings produced by l-NAME. Ikeda and colleagues provide a clue to the mechanism by showing that exposure to l-NAME increases plasma aldosterone 50-fold, and that spironolactone markedly attenuates the renal changes. Thus, chronic l-NAME exposure may turn out to be a model of mineralocorticoid excess.

A new wrinkle: skin manifestations of aging may relate to autonomic dysfunction.

Various mechanisms have been argued for skin wrinkling, one of the hallmarks of aging. We hypothesize that chronic sympathetic bias is a previously unrecognized mechanism for wrinkling. In the acute setting of water immersion, reversible skin wrinkling is a well-known reflex mediated by the autonomic nervous system. We postulate that skin wrinkling results as a local maladaptive manifestation of a global chronic sympathetic bias that emerges during aging. The persistence of such changes may induce additional compensatory remodeling to cause permanent alteration of the skin. Sympatholytic agents may prove beneficial for arresting or ameliorating the development of wrinkles. Conditions that amplify sympathetic bias such as stress, smoking, amphetamine abuse, HIV, heart failure, and transplantation may accelerate wrinkling. Other common diseases of the skin may also arise as particular manifestations of aberrant autonomic activity through induction of vascular and immune dysfunctions. The temporal and spatial distribution of these dermatologic conditions may reflect variation of autonomic balance, which also regulates T helper immune balance. For all of these dermatologic conditions, local and systemic administration of drugs and medical devices that pharmacologically or electrically modulate autonomic nervous system activity may yield benefits as well.

Differential effects of agonists of aldosterone secretion on steroidogenic acute regulatory phosphorylation.

The steroidogenic acute regulatory (StAR) protein mediates cholesterol transport within the mitochondria, and its phosphorylation is believed to be required for steroidogenesis. Increased extracellular potassium concentrations (K(+)), angiotensin II (AngII), and adrenocorticotropic hormone (ACTH) induce aldosterone secretion from bovine adrenal glomerulosa cells. We hypothesized that, although these agonists act via different signaling pathways, StAR phosphorylation should be common to their action. We studied the effects of K(+), AngII, and ACTH, at concentrations that yield comparable secretory responses, on StAR phosphorylation. All three agents induced significant increases in StAR phosphorylation although the response to ACTH was less than that of AngII and K(+). In cells stimulated with the protein kinase C (PKC) agonist 12-tetradecanoylphorbol 13-acetate (TPA), the Ca(2+) channel agonist BAY K8644, and the adenylate cyclase agonist forskolin, TPA caused a small but statistically significant increase in StAR phosphorylation while BAY K8644 and forskolin had no significant effect. Interestingly, the combination of TPA and BAY K8644 produced a larger increase in StAR phosphorylation than the agents alone. We conclude that in cultured bovine adrenal glomerulosa cells the PKC signaling pathway is most effective at inducing StAR phosphorylation but that there is no simple correlation between this event and aldosterone production.

Cysteines 849 and 942 of human mineralocorticoid receptor are crucial for steroid binding.

To assess the role of each of the four cysteine residues in the hormone binding domain (HBD) of the human mineralocorticoid receptor (hMR), we have separately substituted C808, C849, C910, and C942 into serine. These mutations were created in the G595-K984 hMR receptor fragment which encompasses the DNA binding domain, the hinge region, and the hormone binding domain. Each mutant was further analyzed by steroid binding assays and transactivation assays using wild-type and mutant proteins expressed in vitro in the reticulocyte lysate. While the C910S mutant exhibited similar wild-type G595-K984 receptor binding properties for aldosterone, the C808S mutant affinity was 3.5-fold higher. In contrast, the C849S mutant showed a drastic drop in affinity for aldosterone and the mutant C942S was unable to bind the steroid. Affinities for the antagonist progesterone were also determined. C808S, C849S, and C910S were found to bind progesterone better than aldosterone (about a 2-fold increase in their affinities). Mutant C942S failed to bind any steroid tested (aldosterone, progesterone, cortisol, and the synthetic antagonist RU26752). No change in the specificity toward various agonists and antagonists could be observed with the mutants when compared to the wild-type G595-K984. When transactivation assays were performed, the properties of mutants C808S and C910S were similar to those of the wild-type G595-K984, while mutant C849S showed reduced sensitivity and C942S was devoid of any transcriptional activity. Our data indicate that C849 and C942 are critical for the ligand binding process of hMR. Moreover, C942 might be involved in a direct contact with the 20-keto group of the steroid.

Duality of the voltage-dependent calcium influx in adrenal glomerulosa cells.

Both T- and L-type calcium channels are expressed in bovine adrenal glomerulosa cells and both channels are sensitive to moderate depolarizations of the cell membrane induced by angiotensin II (AngII) or physiological concentrations of extracellular K+. These channels present distinct pharmacology, L-type channels being more sensitive to dihydropyridines, whereas T channels are inhibited by lower concentrations of mibefradil, a new type of calcium antagonist currently used for treating hypertension. The activity of these channels is also differently modulated by AngII, which inhibits T channels through activation of protein kinase C and L channels through a Pertussis toxin-sensitive G protein. Finally, whereas the activity of L-type channels is directly reflected on the levels of the cytosolic calcium concentration ([Ca2+]c), T-type channels are more closely related to the control of steroidogenesis, possibly through a kind of "calcium pipeline" linking the plasma membrane to the mitochondria. In conclusion, two types of calcium channels, with distinct functions and differential modulation by AngII, are activated by agonists of aldosterone biosynthesis in adrenal glomerulosa cells. Most importantly, these channels have distinct sensitivities to currently used antihypertensive therapeutic drugs.

[DARC/PELCO structure activity relationships of aldosterone agonists and antagonists]. / Relations structure-affinité DARC/PELCO de stéroïdes agonistes ou antagonistes de l'aldostérone.

To detect the sites essential for binding affinity, we use the DARC/PELCO topological correlation search method and apply it to 52 17-spirolactone or 17-hydroxymethylcarbonyl steroids, aldosterone agonists or antagonists. The optimal model explains 98% of the total variance with a precision close to experimental. The main favourable contributions come from direct substitutions on rings C and D of the steroidal skeleton, the most unfavourable from those on rings A and B. The secondary structural modifications - modifications of existing substituents or second substitutions on the focus - have a slight deactivating influence, except the simultaneous existence of two contiguous double bonds on the 11 beta chain. Structures predicted to have a high affinity are built up by combining the most favourable structural elements: 9 alpha-F, 11 beta-allenyl, delta 11, 12 and 15 beta-, 16 beta-CH2. Some are predicted to have an affinity 100- to 1000-fold higher than aldosterone.