Low Cortisone as a Novel Predictor of the Low-Renin Phenotype

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dc.contributor.authorTapia-Castillo, Alejandra
dc.contributor.authorCarvajal, Cristian A.
dc.contributor.authorPerez, Jorge A.
dc.contributor.authorSandoval, Alejandra
dc.contributor.authorAllende, Fidel
dc.contributor.authorSolari, Sandra
dc.contributor.authorFardella, Carlos E.
dc.date.accessioned2025-01-20T17:06:34Z
dc.date.available2025-01-20T17:06:34Z
dc.date.issued2024
dc.description.abstractA large proportion of patients with low-renin hypertension (LRH) correspond to primary aldosteronism (PA). However, some of these subjects have low to normal aldosterone. Since low renin is driven by excessive mineralocorticoids or glucocorticoids acting on mineralocorticoid receptors (MRs), we hypothesize that a low-cortisone condition, associated classically with 11 beta HSD2 deficiency, is a proxy of chronic MR activation by cortisol, which can also lead to low renin, elevated blood pressure, and renal and vascular alterations. Objective: To evaluate low cortisone as a predictor of low renin activity and its association with parameters of kidney and vascular damage. Methods: A cross-sectional study was carried out in 206 adult subjects. The subjects were classified according to low plasma renin activity (<1 ng/mL x hours) and low cortisone (<25th percentile). Results: Plasma renin activity was associated with aldosterone (r = 0.36; P < .001) and cortisone (r = 0.22; P = .001). A binary logistic regression analysis showed that serum cortisone per ug/dL increase predicted the low-renin phenotype (OR 0.4, 95% CI 0.21-0.78). The receiver operating characteristic curves for cortisone showed an area under the curve of 0.6 to discriminate subjects with low renin activity from controls. The low-cortisone subjects showed higher albuminuria and PAI-1 and lower sodium excretion. The association study also showed that urinary cortisone was correlated with blood pressure and serum potassium (P < .05). Conclusion: This is the first study showing that low cortisone is a predictor of a low-renin condition. Low cortisone also predicted surrogate markers of vascular and renal damage. Since the aldosterone to renin ratio is used in the screening of PA, low cortisone values should be considered additionally to avoid false positives in the aldosterone-renin ratio calculation.
dc.fuente.origenWOS
dc.identifier.doi10.1210/jendso/bvae051
dc.identifier.eissn2472-1972
dc.identifier.urihttps://doi.org/10.1210/jendso/bvae051
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/90805
dc.identifier.wosidWOS:001197780000001
dc.issue.numero6
dc.language.isoen
dc.revistaJournal of the endocrine society
dc.rightsacceso restringido
dc.subjectlow-renin hypertension
dc.subjectcortisol
dc.subjectcortisone
dc.subjectaldosterone
dc.subject.ods03 Good Health and Well-being
dc.subject.odspa03 Salud y bienestar
dc.titleLow Cortisone as a Novel Predictor of the Low-Renin Phenotype
dc.typeartículo
dc.volumen8
sipa.indexWOS
sipa.trazabilidadWOS;2025-01-12
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