Abstract 358: Excess Cardio-renal Damage in Aldosterone-producing Adenoma Patients With Somatic Mutations in the KCNJ5 Gene
Aldosterone exerts detrimental cardiovascular (CV) effects, and aldosterone producing adenoma (APA) patients carrying somatic mutations in the KCNJ5 K+ channel (mutAPA) have higher plasma aldosterone concentration (PAC) than those wild-type (wtAPA).
We therefore investigated whether mutAPA patients develop a more prominent CV and renal damage than wtAPA patients.
From 250 consecutive PA patients, we identified 170 who had a diagnosis of APA by the 'four corners' criteria and high-quality echocardiographic data. Of them 106 with KCNJ5 sequencing information and long-term follow-up data could be compared for echocardiographic changes and eGFR (by CKD-EPI equation) according to presence (mutAPA, 18.8%) or absence (wtAPA, 81.2%) of the KCNJ5 mutations.
At baseline the mutAPA had lower eGFR (75±29 ml/min vs 84±20, p<0.05), and higher left ventricular mass index (LVMI, 61.9±21.4 mg/h2.7vs 49.5±11.3, p=0.001), PAC (48.9 [37.4-77.1] ng/dl vs 37.0 [24.9-48.5]), <0.0001), aldosterone-renin-ratio (ARR, 173.5 [92.2-229.6] ng/dl/ng/ml/h vs 144.3 [69.9-252.1], <0.0001), than the wtAPA patients. They were similar for blood pressure (BP) and need for antihypertensive medications. After adrenalectomy BP, PAC, ARR, and LVMI normalized in all groups, with no difference between mutAPA vs wtAPA.
Compared to the wild-type APA patients those with KCNJ5 mutations showed more prominent cardiovascular and renal damage, likely because of the higher PAC. However, the presence of these mutations did not compromise the chances of being cured from the hyperaldosteronism and the high blood pressure, or the regression of LVMI after adrenalectomy.
- © 2013 by American Heart Association, Inc.