nach oben

Erschienen in:

Open Access 27.06.2020 | Original Article

Spironolactone reduces biochemical markers of bone turnover in postmenopausal women with primary aldosteronism

verfasst von: Christian Adolf, Leah T. Braun, Carmina T. Fuss, Stefanie Hahner, Heike Künzel, Laura Handgriff, Lisa Sturm, Daniel A. Heinrich, Holger Schneider, Martin Bidlingmaier, Martin Reincke

Erschienen in: Endocrine | Ausgabe 3/2020

Einloggen, um Zugang zu erhalten

Abstract

Context

Primary aldosteronism (PA) is the most frequent form of endocrine hypertension. Besides its deleterious impact on cardiovascular target organ damage, PA is considered to cause osteoporosis.

Patients and methods

We assessed bone turnover in a subset of 36 postmenopausal women with PA. 18 patients had unilateral PA and were treated by adrenalectomy, whereas 18 patients had bilateral PA and received mineralocorticoid receptor antagonist (MRA) therapy respectively. 18 age- and BMI-matched females served as controls. To estimate bone remodeling, we measured the bone turnover markers intact procollagen 1 N-terminal propeptide, bone alkaline phosphatase, osteocalcin and tartrate resistant acid phosphatase 5b in plasma by chemiluminescent immunoassays at time of diagnosis and one year after initiation of treatment.

Study design

Observational longitudinal cohort study.

Setting

Tertiary care hospital.

Results

Compared with controls, patients with PA had mildly elevated osteocalcin at baseline (p = 0.013), while the other bone markers were comparable between both groups. There were no differences between the unilateral and the bilateral PA subgroup. One year after initiation of MRA treatment with spironolactone bone resorption and bone formation markers had significantly decreased in patients with bilateral PA. In contrast, patients adrenalectomized because of unilateral PA showed no significant change of bone turnover markers.

Conclusion

This study shows that aldosterone excess in postmenopausal women with PA is not associated with a relevant increase of bone turnover markers at baseline. However, we observed a significant decrease of bone markers in patients treated with spironolactone, but not in patients treated by adrenalectomy.

Nur mit Berechtigung zugänglich

S. Monticone, J. Burrello, D. Tizzani, C. Bertello, A. Viola, F. Buffolo, L. Gabetti, G. Mengozzi, T.A. Williams, F. Rabbia, F. Veglio, P. Mulatero, Prevalence and clinical manifestations of primary aldosteronism encountered in primary care practice. J. Am. Coll. Cardiol. 69(14), 1811–1820 (2017). https://doi.org/10.1016/j.jacc.2017.01.052CrossRefPubMed

G.P. Rossi, G. Bernini, C. Caliumi, G. Desideri, B. Fabris, C. Ferri, C. Ganzaroli, G. Giacchetti, C. Letizia, M. Maccario, F. Mallamaci, M. Mannelli, M.J. Mattarello, A. Moretti, G. Palumbo, G. Parenti, E. Porteri, A. Semplicini, D. Rizzoni, E. Rossi, M. Boscaro, A.C. Pessina, F. Mantero, P.S. Investigators, A prospective study of the prevalence of primary aldosteronism in 1,125 hypertensive patients. J. Am. Coll. Cardiol. 48(11), 2293–2300 (2006). https://doi.org/10.1016/j.jacc.2006.07.059CrossRefPubMed

S. Monticone, F. D’Ascenzo, C. Moretti, T.A. Williams, F. Veglio, F. Gaita, P. Mulatero, Cardiovascular events and target organ damage in primary aldosteronism compared with essential hypertension: a systematic review and meta-analysis. Lancet Diabetes Endocrinol. 6(1), 41–50 (2018). https://doi.org/10.1016/S2213-8587(17)30319-4CrossRefPubMed

A.S. Salcuni, V. Carnevale, C. Battista, S. Palmieri, C. Eller-Vainicher, V. Guarnieri, F. Pugliese, G. Guglielmi, G. Desina, S. Minisola, I. Chiodini, A. Scillitani, Primary aldosteronism as a cause of secondary osteoporosis. Eur. J. Endocrinol. 177(5), 431–437 (2017). https://doi.org/10.1530/EJE-17-0417CrossRefPubMed

H. Remde, G. Hanslik, N. Rayes, M. Quinkler, Glucose metabolism in primary aldosteronism. Horm. Metab. Res. 47(13), 987–993 (2015). https://doi.org/10.1055/s-0035-1565208CrossRefPubMed

M. Stowasser, J. Sharman, R. Leano, R.D. Gordon, G. Ward, D. Cowley, T.H. Marwick, Evidence for abnormal left ventricular structure and function in normotensive individuals with familial hyperaldosteronism type I. J. Clin. Endocrinol. Metab. 90(9), 5070–5076 (2005). https://doi.org/10.1210/jc.2005-0681CrossRefPubMed

P.H. Law, Y. Sun, S.K. Bhattacharya, V.S. Chhokar, K.T. Weber, Diuretics and bone loss in rats with aldosteronism. J. Am. Coll. Cardiol. 46(1), 142–146 (2005). https://doi.org/10.1016/j.jacc.2005.03.055CrossRefPubMed

A.L. Runyan, V.S. Chhokar, Y. Sun, S.K. Bhattacharya, J.W. Runyan, K.T. Weber, Bone loss in rats with aldosteronism. Am. J. Med Sci. 330(1), 1–7 (2005). https://doi.org/10.1097/00000441-200507000-00001CrossRefPubMed

A.S. Salcuni, S. Palmieri, V. Carnevale, V. Morelli, C. Battista, V. Guarnieri, G. Guglielmi, G. Desina, C. Eller-Vainicher, P. Beck-Peccoz, A. Scillitani, I. Chiodini, Bone involvement in aldosteronism. J. Bone Min. Res 27(10), 2217–2222 (2012). https://doi.org/10.1002/jbmr.1660CrossRef

10.

M. Notsu, M. Yamauchi, M. Yamamoto, K. Nawata, T. Sugimoto, Primary aldosteronism as a risk factor for vertebral fracture. J. Clin. Endocrinol. Metab. 102(4), 1237–1243 (2017). https://doi.org/10.1210/jc.2016-3206CrossRefPubMed

11.

V.C. Wu, C.H. Chang, C.Y. Wang, Y.H. Lin, T.W. Kao, P.C. Lin, T.S. Chu, Y.S. Chang, L. Chen, K.D. Wu, S.J. Chueh, Risk of fracture in primary aldosteronism: a population-based cohort study. J. Bone Min. Res. 32(4), 743–752 (2017). https://doi.org/10.1002/jbmr.3033CrossRef

12.

B.J. Kim, M.K. Kwak, S.H. Ahn, H. Kim, S.H. Lee, J.M. Koh, Lower trabecular bone score in patients with primary aldosteronism: human skeletal deterioration by aldosterone excess. J. Clin. Endocrinol. Metab. 103(2), 615–621 (2018). https://doi.org/10.1210/jc.2017-02043CrossRefPubMed

13.

C.H. Wu, Y.F. Chang, C.H. Chen, E.M. Lewiecki, C. Wuster, I. Reid, K.S. Tsai, T. Matsumoto, L.B. Mercado-Asis, D.C. Chan, J.S. Hwang, C.L. Cheung, K. Saag, J.K. Lee, S.T. Tu, W. Xia, W. Yu, Y.S. Chung, P. Ebeling, A. Mithal, S.L. Ferrari, C. Cooper, G.T. Lin, R.S. Yang, Consensus statement on the use of bone turnover markers for short-term monitoring of osteoporosis treatment in the Asia-Pacific Region. J. Clin. Densitom. (2019). https://doi.org/10.1016/j.jocd.2019.03.004

14.

L. Ceccoli, V. Ronconi, L. Giovannini, M. Marcheggiani, F. Turchi, M. Boscaro, G. Giacchetti, Bone health and aldosterone excess. Osteoporos. Int. 24(11), 2801–2807 (2013). https://doi.org/10.1007/s00198-013-2399-1CrossRefPubMed

15.

H.H. Loh, N.A. Kamaruddin, R. Zakaria, N. Sukor, Improvement of bone turnover markers and bone mineral density following treatment of primary aldosteronism. Minerva Endocrinol. 43(2), 117–125 (2018). https://doi.org/10.23736/S0391-1977.16.02553-0CrossRefPubMed

16.

A. Hannemann, H. Wallaschofski, Reference intervals for serum concentrations of three bone turnover markers for men and women. Bone 93, 216 (2016). https://doi.org/10.1016/j.bone.2015.06.020CrossRefPubMed

17.

A. Morovat, A. Catchpole, A. Meurisse, A. Carlisi, A.C. Bekaert, O. Rousselle, M. Paddon, T. James, E. Cavalier, IDS iSYS automated intact procollagen-1-N-terminus pro-peptide assay: method evaluation and reference intervals in adults and children. Clin. Chem. Lab. Med. 51(10), 2009–2018 (2013). https://doi.org/10.1515/cclm-2012-0531CrossRefPubMed

18.

H.A. Morris, R. Eastell, N.R. Jorgensen, E. Cavalier, S. Vasikaran, S.A.P. Chubb, J.A. Kanis, C. Cooper, K. Makris, I.-I.W.G.F.S.O.B.M. Assays, Clinical usefulness of bone turnover marker concentrations in osteoporosis. Clin. Chim. Acta 467, 34–41 (2017). https://doi.org/10.1016/j.cca.2016.06.036CrossRefPubMed

19.

A. Hannemann, N. Friedrich, C. Spielhagen, R. Rettig, T. Ittermann, M. Nauck, H. Wallaschofski, Reference intervals for serum osteocalcin concentrations in adult men and women from the study of health in Pomerania. BMC Endocr. Disord. 13, 11 (2013). https://doi.org/10.1186/1472-6823-13-11CrossRefPubMedPubMedCentral

20.

J.W. Funder, R.M. Carey, F. Mantero, M.H. Murad, M. Reincke, H. Shibata, M. Stowasser, W.F. Young Jr., The management of primary aldosteronism: case detection, diagnosis, and treatment: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 101(5), 1889–1916 (2016). https://doi.org/10.1210/jc.2015-4061CrossRefPubMed

21.

M.J. Betz, C. Degenhart, E. Fischer, A. Pallauf, V. Brand, U. Linsenmaier, F. Beuschlein, M. Bidlingmaier, M. Reincke, Adrenal vein sampling using rapid cortisol assays in primary aldosteronism is useful in centers with low success rates. Eur. J. Endocrinol. 165(2), 301–306 (2011). https://doi.org/10.1530/EJE-11-0287CrossRefPubMed

22.

S. Athimulam, I. Bancos, Evaluation of bone health in patients with adrenal tumors. Curr. Opin. Endocrinol. Diabetes Obes. 26(3), 125–132 (2019). https://doi.org/10.1097/MED.0000000000000478CrossRefPubMed

23.

B.J. Kim, S.H. Lee, J.M. Koh, Bone health in adrenal disorders. Endocrinol. Metab. 33(1), 1–8 (2018). https://doi.org/10.3803/EnM.2018.33.1.1CrossRef

24.

S. Beavan, A. Horner, S. Bord, D. Ireland, J. Compston, Colocalization of glucocorticoid and mineralocorticoid receptors in human bone. J. Bone Min. Res. 16(8), 1496–1504 (2001). https://doi.org/10.1359/jbmr.2001.16.8.1496CrossRef

25.

L. Petramala, L. Zinnamosca, A. Settevendemmie, C. Marinelli, M. Nardi, A. Concistre, F. Corpaci, G. Tonnarini, G. De Toma, C. Letizia, Bone and mineral metabolism in patients with primary aldosteronism. Int. J. Endocrinol. 2014, 836529 (2014). https://doi.org/10.1155/2014/836529

26.

M. Gupta, C.L. Cheung, Y.H. Hsu, S. Demissie, L.A. Cupples, D.P. Kiel, D. Karasik, Identification of homogeneous genetic architecture of multiple genetically correlated traits by block clustering of genome-wide associations. J. Bone Min. Res. 26(6), 1261–1271 (2011). https://doi.org/10.1002/jbmr.333CrossRef

27.

W. Arlt, K. Lang, A.J. Sitch, A.S. Dietz, Y. Rhayem, I. Bancos, A. Feuchtinger, V. Chortis, L.C. Gilligan, P. Ludwig, A. Riester, E. Asbach, B.A. Hughes, D.M. O’Neil, M. Bidlingmaier, J.W. Tomlinson, Z.K. Hassan-Smith, D.A. Rees, C. Adolf, S. Hahner, M. Quinkler, T. Dekkers, J. Deinum, M. Biehl, B.G. Keevil, C.H.L. Shackleton, J.J. Deeks, A.K. Walch, F. Beuschlein, M. Reincke, Steroid metabolome analysis reveals prevalent glucocorticoid excess in primary aldosteronism. JCI Insight 2(8), (2017). https://doi.org/10.1172/jci.insight.93136

28.

C. Adolf, A. Kohler, A. Franke, K. Lang, A. Riester, A. Low, D.A. Heinrich, M. Bidlingmaier, M. Treitl, R. Ladurner, F. Beuschlein, W. Arlt, M. Reincke, Cortisol excess in patients with primary aldosteronism impacts left ventricular hypertrophy. J. Clin. Endocrinol. Metab. 103(12), 4543–4552 (2018). https://doi.org/10.1210/jc.2018-00617CrossRefPubMed

29.

J. Gerards, D.A. Heinrich, C. Adolf, C. Meisinger, W. Rathmann, L. Sturm, N. Nirschl, M. Bidlingmaier, F. Beuschlein, B. Thorand, A. Peters, M. Reincke, M. Roden, M. Quinkler, Impaired glucose metabolism in primary aldosteronism is associated with cortisol co-secretion. J. Clin. Endocrinol. Metab. (2019). https://doi.org/10.1210/jc.2019-00299

30.

S. Fatahi, N. Namazi, B. Larijani, L. Azadbakht, The association of dietary and urinary sodium with bone mineral density and risk of osteoporosis: a systematic review and meta-analysis. J. Am. Coll. Nutr. 37(6), 522–532 (2018). https://doi.org/10.1080/07315724.2018.1431161CrossRefPubMed

31.

S.M. Park, J.Y. Joung, Y.Y. Cho, S.Y. Sohn, K.Y. Hur, J.H. Kim, S.W. Kim, J.H. Chung, M.K. Lee, Y.K. Min, Effect of high dietary sodium on bone turnover markers and urinary calcium excretion in Korean postmenopausal women with low bone mass. Eur. J. Clin. Nutr. 69(3), 361–366 (2015). https://doi.org/10.1038/ejcn.2014.284CrossRefPubMed

32.

H.Y. Dar, A. Singh, P. Shukla, R. Anupam, R.K. Mondal, P.K. Mishra, R.K. Srivastava, High dietary salt intake correlates with modulated Th17-Treg cell balance resulting in enhanced bone loss and impaired bone-microarchitecture in male mice. Sci. Rep. 8(1), 2503 (2018). https://doi.org/10.1038/s41598-018-20896-yCrossRefPubMedPubMedCentral

33.

S.J. Kwon, Y.C. Ha, Y. Park, High dietary sodium intake is associated with low bone mass in postmenopausal women: Korea National Health and Nutrition Examination Survey, 2008-2011. Osteoporos. Int. 28(4), 1445–1452 (2017). https://doi.org/10.1007/s00198-017-3904-8CrossRefPubMed

34.

J.L. Bedford, S.I. Barr, Higher urinary sodium, a proxy for intake, is associated with increased calcium excretion and lower hip bone density in healthy young women with lower calcium intakes. Nutrients 3(11), 951–961 (2011). https://doi.org/10.3390/nu3110951CrossRefPubMedPubMedCentral

35.

A. Devine, R.A. Criddle, I.M. Dick, D.A. Kerr, R.L. Prince, A longitudinal study of the effect of sodium and calcium intakes on regional bone density in postmenopausal women. Am. J. Clin. Nutr. 62(4), 740–745 (1995). https://doi.org/10.1093/ajcn/62.4.740CrossRefPubMed

36.

T. Remer, High salt intake: detrimental not only for blood pressure, but also for bone health? Endocrine 49(3), 580–582 (2015). https://doi.org/10.1007/s12020-015-0626-6CrossRefPubMed

37.

M. Sereg, J. Toke, A. Patocs, I. Varga, P. Igaz, N. Szucs, J. Horanyi, P. Pusztai, S. Czirjak, E. Glaz, K. Racz, M. Toth, Diagnostic performance of salivary cortisol and serum osteocalcin measurements in patients with overt and subclinical Cushing’s syndrome. Steroids 76(1-2), 38–42 (2011). https://doi.org/10.1016/j.steroids.2010.08.007CrossRefPubMed

38.

A. Szappanos, J. Toke, D. Lippai, A. Patocs, P. Igaz, N. Szucs, L. Futo, E. Glaz, K. Racz, M. Toth, Bone turnover in patients with endogenous Cushing’s syndrome before and after successful treatment. Osteoporos. Int. 21(4), 637–645 (2010). https://doi.org/10.1007/s00198-009-0978-yCrossRefPubMed

39.

G. Osella, M. Terzolo, G. Reimondo, A. Piovesan, A. Pia, A. Termine, P. Paccotti, A. Angeli, Serum markers of bone and collagen turnover in patients with Cushing’s syndrome and in subjects with adrenal incidentalomas. J. Clin. Endocrinol. Metab. 82(10), 3303–3307 (1997). https://doi.org/10.1210/jcem.82.10.4282CrossRefPubMed

40.

S. Bardet, V. Rohmer, F. Boux de Casson, C. Coffin, N. Ronci, J.P. Sabatier, P. Lecomte, M. Audran, M. Henry-Amar, A. Tabarin, [Bone mineral density and biological markers of bone repair in patients with adrenal incidentaloma: effect of subclinical hypercortisolism]. Rev. Med Interne 23(6), 508–517 (2002). https://doi.org/10.1016/s0248-8663(02)00606-9CrossRefPubMed

41.

A. Sartorio, A. Conti, S. Ferrero, S. Giambona, T. Re, E. Passini, B. Ambrosi, Evaluation of markers of bone and collagen turnover in patients with active and preclinical Cushing’s syndrome and in patients with adrenal incidentaloma. Eur. J. Endocrinol. 138(2), 146–152 (1998). https://doi.org/10.1530/eje.0.1380146CrossRefPubMed

42.

P.D. Ross, W. Knowlton, Rapid bone loss is associated with increased levels of biochemical markers. J. Bone Min. Res. 13(2), 297–302 (1998). https://doi.org/10.1359/jbmr.1998.13.2.297CrossRef

43.

P. Gerdhem, K.K. Ivaska, S.L. Alatalo, J.M. Halleen, J. Hellman, A. Isaksson, K. Pettersson, H.K. Vaananen, K. Akesson, K.J. Obrant, Biochemical markers of bone metabolism and prediction of fracture in elderly women. J. Bone Min. Res. 19(3), 386–393 (2004). https://doi.org/10.1359/JBMR.0301244CrossRef

44.

P. Moghetti, R. Castello, N. Zamberlan, M. Rossini, D. Gatti, C. Negri, F. Tosi, M. Muggeo, S. Adami, Spironolactone, but not flutamide, administration prevents bone loss in hyperandrogenic women treated with gonadotropin-releasing hormone agonist. J. Clin. Endocrinol. Metab. 84(4), 1250–1254 (1999). https://doi.org/10.1210/jcem.84.4.5606CrossRefPubMed

45.

L.D. Carbone, J.D. Cross, S.H. Raza, A.J. Bush, R.J. Sepanski, S. Dhawan, B.Q. Khan, M. Gupta, K. Ahmad, R.N. Khouzam, D.A. Dishmon, J.P. Nesheiwat, M.A. Hajjar, W.A. Chishti, W. Nasser, M. Khan, C.R. Womack, T. Cho, A.R. Haskin, K.T. Weber, Fracture risk in men with congestive heart failure risk reduction with spironolactone. J. Am. Coll. Cardiol. 52(2), 135–138 (2008). https://doi.org/10.1016/j.jacc.2008.03.039CrossRefPubMed

46.

J.I. Barzilay, B.R. Davis, S.L. Pressel, A. Ghosh, R. Puttnam, K.L. Margolis, P.K. Whelton, The impact of antihypertensive medications on bone mineral density and fracture risk. Curr. Cardiol. Rep. 19(9), 76 (2017). https://doi.org/10.1007/s11886-017-0888-0CrossRefPubMed

47.

E. Rossi, C. Sani, F. Perazzoli, M.C. Casoli, A. Negro, C. Dotti, Alterations of calcium metabolism and of parathyroid function in primary aldosteronism, and their reversal by spironolactone or by surgical removal of aldosterone-producing adenomas. Am. J. Hypertens. 8(9), 884–893 (1995). https://doi.org/10.1016/0895-7061(95)00182-OCrossRefPubMed

48.

V.S. Chhokar, Y. Sun, S.K. Bhattacharya, R.A. Ahokas, L.K. Myers, Z. Xing, R.A. Smith, I.C. Gerling, K.T. Weber, Hyperparathyroidism and the calcium paradox of aldosteronism. Circulation 111(7), 871–878 (2005). https://doi.org/10.1161/01.CIR.0000155621.10213.06CrossRefPubMed

49.

R.K. Rude, F.R. Singer, H.E. Gruber, Skeletal and hormonal effects of magnesium deficiency. J. Am. Coll. Nutr. 28(2), 131–141 (2009). https://doi.org/10.1080/07315724.2009.10719764CrossRefPubMed

50.

J. Ha, S.A. Kim, K. Lim, S. Shin, The association of potassium intake with bone mineral density and the prevalence of osteoporosis among older Korean adults. Nutr. Res Pract. 14(1), 55–61 (2020). https://doi.org/10.4162/nrp.2020.14.1.55CrossRefPubMedPubMedCentral

51.

S.H. Kong, J.H. Kim, A.R. Hong, J.H. Lee, S.W. Kim, C.S. Shin, Dietary potassium intake is beneficial to bone health in a low calcium intake population: the Korean National Health and Nutrition Examination Survey (KNHANES) (2008-2011). Osteoporos. Int. 28(5), 1577–1585 (2017). https://doi.org/10.1007/s00198-017-3908-4CrossRefPubMed

52.

A.O. Aluoch, R. Jessee, H. Habal, M. Garcia-Rosell, R. Shah, G. Reed, L. Carbone, Heart failure as a risk factor for osteoporosis and fractures. Curr. Osteoporos. Rep. 10(4), 258–269 (2012). https://doi.org/10.1007/s11914-012-0115-2CrossRefPubMed

53.

T.J. de Villiers, C. Altomare, M. Particco, M. Gambacciani, Effects of ospemifene on bone in postmenopausal women. Climacteric 22(5), 442–447 (2019). https://doi.org/10.1080/13697137.2019.1631789CrossRefPubMed

54.

T. Fumoto, K.A. Ishii, M. Ito, S. Berger, G. Schutz, K. Ikeda, Mineralocorticoid receptor function in bone metabolism and its role in glucocorticoid-induced osteopenia. Biochem Biophys. Res Commun. 447(3), 407–412 (2014). https://doi.org/10.1016/j.bbrc.2014.03.149CrossRefPubMed

Titel: Spironolactone reduces biochemical markers of bone turnover in postmenopausal women with primary aldosteronism
verfasst von: Christian Adolf
Leah T. Braun
Carmina T. Fuss
Stefanie Hahner
Heike Künzel
Laura Handgriff
Lisa Sturm
Daniel A. Heinrich
Holger Schneider
Martin Bidlingmaier
Martin Reincke
Publikationsdatum: 27.06.2020
Verlag: Springer US
Erschienen in: Endocrine / Ausgabe 3/2020
Print ISSN: 1355-008X
Elektronische ISSN: 1559-0100
DOI: https://doi.org/10.1007/s12020-020-02348-8

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

Reizdarmsyndrom: Diäten wirksamer als Medikamente

29.04.2024 Reizdarmsyndrom Nachrichten

Bei Reizdarmsyndrom scheinen Diäten, wie etwa die FODMAP-arme oder die kohlenhydratreduzierte Ernährung, effektiver als eine medikamentöse Therapie zu sein. Das hat eine Studie aus Schweden ergeben, die die drei Therapieoptionen im direkten Vergleich analysierte.

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Bei schweren Reaktionen auf Insektenstiche empfiehlt sich eine spezifische Immuntherapie

25.04.2024 Allergien und Intoleranzreaktionen Nachrichten

Insektenstiche sind bei Erwachsenen die häufigsten Auslöser einer Anaphylaxie. Einen wirksamen Schutz vor schweren anaphylaktischen Reaktionen bietet die allergenspezifische Immuntherapie. Jedoch kommt sie noch viel zu selten zum Einsatz.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Context

Patients and methods

Study design

Setting

Results

Conclusion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 3/2020

Do reductions in risk of cardiorenal events with SGLT2 inhibitors in type 2 diabetes vary with baseline characteristics? A meta-analysis

Cell proliferation, apoptosis, and angiogenesis in non-functional pituitary adenoma: association with tumor invasiveness

High rate incidence of post-surgical adverse events in patients with low-risk papillary thyroid cancer who did not accept active surveillance

Effects of denosumab as compared with parathyroidectomy regarding calcium, renal, and bone involvement in osteoporotic patients with primary hyperparathyroidism

Characterization of agonist-dependent somatostatin receptor subtype 2 trafficking in neuroendocrine cells