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Effects of mineralocorticoid receptor antagonists on sex hormones and body composition in patients with primary aldosteronism

Hypertension Research volume 45, pages 496–506 (2022)Cite this article

Abstract

Mineralocorticoid receptor antagonists are frequently used for the treatment of primary aldosteronism. Steroidal mineralocorticoid receptor antagonists may have antagonistic actions on androgen receptors, agonistic actions on progesterone receptors, and antagonistic actions on mineralocorticoid receptors. Because anti-androgen effects may cause body fat accumulation and skeletal muscle atrophy, there are concerns that this drug may have adverse effects on body composition. Therefore, in this randomized prospective study, we compared the adverse effects of spironolactone, a steroidal mineralocorticoid receptor antagonist, and esaxerenone, a nonsteroidal mineralocorticoid receptor antagonist, on sex hormone levels and body composition in patients with primary aldosteronism without severe renal dysfunction. The serum concentration of free testosterone was significantly higher in the spironolactone group than in the esaxerenone group in both males and females. However, the levels of estradiol, progesterone, luteinizing hormone, and follicle stimulating hormone did not significantly increase. Changes in body fat percentage and muscle mass rate were not significantly different between the two groups. No patient showed a serum potassium level ≥6.0 mEq/L; however, serum potassium levels were significantly higher in the spironolactone group than in the esaxerenone group. These data indicate that spironolactone may have antagonistic effects on androgen receptors. Esaxerenone did not show any apparent adverse effects, suggesting that it can be safely used in patients with primary aldosteronism.

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Acknowledgements

We would like to thank the ward staff and physicians who took good care of the patients enrolled in this study.

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Authors and Affiliations

  1. Department of Endocrinology and Hypertension, Tokyo Women’s Medical University, Tokyo, Japan

    Toru Ishikawa, Satoshi Morimoto & Atsuhiro Ichihara

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  1. Toru Ishikawa
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  3. Atsuhiro Ichihara
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Contributions

The study was designed by TI and AI. Data analysis and interpretation were conducted by TI and SM. The manuscript was written by TS and SM and was approved by AI.

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Correspondence to Satoshi Morimoto.

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SM and AI received honorarium as a lecture fee from Daiichi Sankyo Company Limited.

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Ishikawa, T., Morimoto, S. & Ichihara, A. Effects of mineralocorticoid receptor antagonists on sex hormones and body composition in patients with primary aldosteronism. Hypertens Res 45, 496–506 (2022). https://doi.org/10.1038/s41440-021-00836-6

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