Research led by scientists at the University of Birmingham in the United Kingdom has identified a new cause of hypertension that could lead to major changes in managing the disease.
Previous studies have estimated that 40% of adults have hypertension, but most patients have no identifiable cause of the condition. It is known, however, that up to 10% of hypertensive patients have overproduction of the adrenal hormone aldosterone––a condition known as primary aldosteronism or Conn syndrome––as the cause of their disease.
The new study, published in JCI Insight, made the important discovery that many patients with Conn syndrome overproduce not only aldosterone but also the stress hormone cortisol. The investigators decided to name this new cause of hypertension––the combined overproduction of aldosterone and cortisol––as Connshing syndrome.
The researchers used highly sensitive mass spectrometry to analyse aldosterone and cortisol levels in patients’ urine samples. They found that waist circumference, insulin, diabetes risk, and cholesterol were associated with cortisol production but not with aldosterone production. The researchers also found that overproduction of cortisol was associated with an increased amount of a cortisol-producing enzyme, cytochrome P450-11B1 (CYP11B1), in the adrenal glands of patients who underwent surgical removal of one of their adrenals.
Currently, many patients with Conn syndrome receive drugs that are directed against the adverse effects of aldosterone. However, this leaves the cortisol excess untreated.
“These findings are very likely to change clinical practice,” said investigator Dr. Katharina Lang. “Patients will now need to undergo more-detailed assessment to clarify whether they suffer from Conn or Connshing syndrome.
“Previously, patients with Conn syndrome were never assessed for the overproduction of other hormones, but this will now change thanks to the results of this study.
“Also, researchers now will need to investigate whether treating Connshing patients with an additional drug, which counteracts the cortisol excess, will improve their health outcomes.”
Source: University of Birmingham; April 21, 2017.