title: Gender differences in anxiety and depressive symptoms in patients with primary hyperaldosteronism: a cross-sectional study.
abstract: OBJECTIVE
  The renin-angiotensin-aldosterone-system (RAAS) has gained increasing attention in the investigation of the pathogenesis of depression. Primary hyperaldosteronism (PA) is associated with a marked aldosterone excess. Prior studies on PA describe an increased prevalence of anxiety and sub-threshold depressive symptoms in these patients.
  
  
  METHODS
  In a cross-sectional exploratory study we investigated 132 patients with PA. Twenty-seven patients were studied before initiation of specific treatment (U = untreated), 56 were studied 5.4 years after initiation of mineralocorticoid antagonist treatment (MRA) and 49 patients were studied 4.3 years after unilateral adrenalectomy (ADX). GAD-7 and PHQD self-rating questionnaires were used to assess symptoms for anxiety and depression.
  
  
  RESULTS
  No significant difference was found between the three investigated groups. A higher prevalence for depression and anxiety compared to the normal population was found. Women of all groups had higher mean values compared to men, for depression in untreated patients this difference was found to be significant. Correlations between the psychopathology and hormones were only found for renin. Plasma renin concentration correlated significantly with anxious symptoms of untreated females.
  
  
  CONCLUSIONS
  This study supports the RAAS to be involved in the pathogenesis of depression as patients with PA seem to be more depressive and anxious compared to the normal population. Gender differences in the regulation of the RAAS seem to be apparent, as females were more affected by the dysregulation than males.
authors.affiliation: Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität München , München , Germany.
authors.forename: Konstantina
authors.initials: K
authors.lastname: Apostolopoulou
authors.forename: Heike E
authors.initials: HE
authors.lastname: Künzel
authors.forename: Sabine
authors.initials: S
authors.lastname: Gerum
authors.forename: Katrin
authors.initials: K
authors.lastname: Merkle
authors.forename: Sebastian
authors.initials: S
authors.lastname: Schulz
authors.forename: Evelyn
authors.initials: E
authors.lastname: Fischer
authors.forename: Anna
authors.initials: A
authors.lastname: Pallauf
authors.forename: Volker
authors.initials: V
authors.lastname: Brand
authors.forename: Martin
authors.initials: M
authors.lastname: Bidlingmaier
authors.forename: Stephan
authors.initials: S
authors.lastname: Endres
authors.forename: Felix
authors.initials: F
authors.lastname: Beuschlein
authors.forename: Martin
authors.initials: M
authors.lastname: Reincke
mesh_terms: D000315:Adrenalectomy / Q000706:statistics & numerical data; D000328:Adult; D000367:Age Factors; D000368:Aged; D001007:Anxiety / Q000453:epidemiology / Q000378:metabolism* / Q000503:physiopathology*; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology / Q000378:metabolism* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000453:epidemiology / Q000378:metabolism* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012042:Registries; D012737:Sex Factors; D013997:Time Factors