The Impact of Glucocorticoid Co-Secretion in Primary Aldosteronism on
                    Thyroid Autoantibody Titers During the Course of Disease

Laura Handgriff; Christian Adolf; Daniel A. Heinrich; Leah Braun; Nina Nirschl; Lisa Sturm; Roland Ladurner; Jens Ricke; Max Seidensticker; Martin Bidlingmaier; Martin Reincke

doi:10.1055/a-1164-1944

Hormone and Metabolic Research, Table of Contents

CC BY-NC-ND 4.0 · Horm Metab Res 2020; 52(06): 404-411
DOI: 10.1055/a-1164-1944

Endocrine Research

The Impact of Glucocorticoid Co-Secretion in Primary Aldosteronism on Thyroid Autoantibody Titers During the Course of Disease

Laura Handgriff

¹Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany

,

Christian Adolf

¹Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany

,

Daniel A. Heinrich

¹Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany

,

Leah Braun

¹Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany

,

Nina Nirschl

¹Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany

,

Lisa Sturm

¹Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany

,

Roland Ladurner

²Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Klinikum der Universität München, Munich, Germany

,

Jens Ricke

³Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Munich, Germany

,

Max Seidensticker

³Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Munich, Germany

,

Martin Bidlingmaier

¹Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany

,

Martin Reincke

¹Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany

› Author Affiliations

Abstract

Excess aldosterone is associated with the increased risk of cardio-/cerebrovascular events as well as metabolic comorbidities not only due to its hypertensive effect but also due to its proinflammatory action. Autonomous cortisol secretion (ACS) in the setting of primary aldosteronism (PA) is known to worsen cardiovascular outcome and potentially exhibit immunosuppressive effects. The aim of this study was to determine the impact of ACS status in patients with PA on kinetics of thyroid autoantibodies (anti-TPO, anti-TG) pre and post therapy initiation. Ninety-seven PA patients (43 unilateral, 54 with bilateral PA) from the database of the German Conn’s Registry were included. Anti-TPO and anti-TG levels were measured pre and 6–12 months post therapeutic intervention. Patients were assessed for ACS according to their 24- hour urinary cortisol excretion, late night salivary cortisol and low-dose dexamethasone suppression test. Abnormal test results in line with ACS were identified in 74.2% of patients with PA. Following adrenalectomy, significant increases in anti-TPO levels were observed in patients with at least one abnormal test (p = 0.049), adrenalectomized patients with at least two pathological ACS tests (p = 0.015) and adrenalectomized patients with pathologic dexamethasone suppression tests (p = 0.018). No antibody increases were observed in unilateral PA patients without ACS and in patients with bilateral PA receiving mineralocorticoid antagonist therapy (MRA). Our data are in line with an immunosuppressive effect of mild glucocorticoid excess in PA on thyroid autoantibody titers. This effect is uncovered by adrenalectomy, but not by MRA treatment.

Key words

primary aldosteronism - auto-immune disease - adrenalectomy - thyroid - cortisol secretion - auto-antibodies

Full Text

References

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