title: Deciphering the Role of Vasopressin in Primary Aldosteronism.
abstract: BACKGROUND
  The role of vasopressin (AVP) in the pathophysiology of primary aldosteronism (PA) remains unclear.
  
  
  OBJECTIVE
  The primary aim of this study was to investigate AVP secretion in PA by measuring the plasma concentration of copeptin (PCop), the C-terminal portion of provasopressin. The secondary aim was to assess renal sensitivity to AVP.
  
  
  METHODS
  This was a cross-sectional study in a tertiary-care hospital.
  
  
  METHODS
  We recruited 115 patients with PA, 48 patients with essential hypertension (EH), and 108 normotensive healthy subjects (HS). Blood was sampled for biochemical and hormonal evaluations in fasting condition after 1-h rest in supine position. Osmolality was determined in 24-h urine. PCop was determined by immunoassay.
  
  
  METHODS
  The main outcome measure was adjusted difference in PCop between groups.
  
  
  RESULTS
  After adjustment for sex, body mass index, systolic blood pressure, natremia, and kalemia, PCop was significantly higher in patients with PA than in HS (geometric mean ratio, 1.61; 95% confidence interval [CI], 1.26-2.06; P < .0001) and patients with EH (1.40; 95% CI, 1.08-1.82; P = .0070) PCop was positively correlated with natremia (P = .0094). Urine osmolality was significantly lower in patients with PA than in HS (0.82; 95% CI, 0.74-0.92; P = .0002) and 24-h urinary output was significantly higher in patients with PA than in HS (1.32; 95% CI, 1.11-1.56; P = .0005). The relationship between urine osmolality and PCop was shifted downward in patients with PA but was similar in patients with EH and HS, indicating peripheral resistance to AVP.
  
  
  CONCLUSIONS
  PCop increases in patients with PA in response to an increase in natremia and a renal resistance phenomenon, indicating that AVP release is chronically stimulated in PA.
authors.affiliation: Department of Internal Medicine (L.N.), Centro Hospitalar São João, 4200-319 Porto, Portugal; Center for Health Technology and Services Research, Faculty of Medicine (L.N.), University of Porto, 4099-002 Porto, Portugal; Université Paris Descartes, Faculté de Médecine (A.B., A.L., V.Z., S.B., L.A., P.-F.P., J.M., M.A.), Sorbonne Paris Cité F-75006 Paris, France; Assistance Publique Hôpitaux de Paris (A.B., E.C., A.L. V.Z., M.A.), Hôpital Européen Georges Pompidou, Centre d'Investigation Clinique, F-75015 Paris, France; INSERM, CIC 1418 (A.B., D.B., M.A.), F-75015 Paris, France; Laboratoire de Biomathématiques, Faculté de Pharmacie (E.C.), Université Paris Descartes, Sorbonne Paris Cité, F-75005 Paris, INSERM, UMR 1144 (E.C.), F-75015 Paris, France; and Département de Physiologie-Explorations Fonctionnelles (S.B.), and Unité d'Hypertension Artérielle (L.A., G.B., P.-F.P., M.A.), Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 75015 Paris, France.
authors.forename: Luis
authors.initials: L
authors.lastname: Nogueira-Silva
authors.affiliation: Department of Internal Medicine (L.N.), Centro Hospitalar São João, 4200-319 Porto, Portugal; Center for Health Technology and Services Research, Faculty of Medicine (L.N.), University of Porto, 4099-002 Porto, Portugal; Université Paris Descartes, Faculté de Médecine (A.B., A.L., V.Z., S.B., L.A., P.-F.P., J.M., M.A.), Sorbonne Paris Cité F-75006 Paris, France; Assistance Publique Hôpitaux de Paris (A.B., E.C., A.L. V.Z., M.A.), Hôpital Européen Georges Pompidou, Centre d'Investigation Clinique, F-75015 Paris, France; INSERM, CIC 1418 (A.B., D.B., M.A.), F-75015 Paris, France; Laboratoire de Biomathématiques, Faculté de Pharmacie (E.C.), Université Paris Descartes, Sorbonne Paris Cité, F-75005 Paris, INSERM, UMR 1144 (E.C.), F-75015 Paris, France; and Département de Physiologie-Explorations Fonctionnelles (S.B.), and Unité d'Hypertension Artérielle (L.A., G.B., P.-F.P., M.A.), Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 75015 Paris, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Blanchard
authors.affiliation: Department of Internal Medicine (L.N.), Centro Hospitalar São João, 4200-319 Porto, Portugal; Center for Health Technology and Services Research, Faculty of Medicine (L.N.), University of Porto, 4099-002 Porto, Portugal; Université Paris Descartes, Faculté de Médecine (A.B., A.L., V.Z., S.B., L.A., P.-F.P., J.M., M.A.), Sorbonne Paris Cité F-75006 Paris, France; Assistance Publique Hôpitaux de Paris (A.B., E.C., A.L. V.Z., M.A.), Hôpital Européen Georges Pompidou, Centre d'Investigation Clinique, F-75015 Paris, France; INSERM, CIC 1418 (A.B., D.B., M.A.), F-75015 Paris, France; Laboratoire de Biomathématiques, Faculté de Pharmacie (E.C.), Université Paris Descartes, Sorbonne Paris Cité, F-75005 Paris, INSERM, UMR 1144 (E.C.), F-75015 Paris, France; and Département de Physiologie-Explorations Fonctionnelles (S.B.), and Unité d'Hypertension Artérielle (L.A., G.B., P.-F.P., M.A.), Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 75015 Paris, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Curis
authors.affiliation: Department of Internal Medicine (L.N.), Centro Hospitalar São João, 4200-319 Porto, Portugal; Center for Health Technology and Services Research, Faculty of Medicine (L.N.), University of Porto, 4099-002 Porto, Portugal; Université Paris Descartes, Faculté de Médecine (A.B., A.L., V.Z., S.B., L.A., P.-F.P., J.M., M.A.), Sorbonne Paris Cité F-75006 Paris, France; Assistance Publique Hôpitaux de Paris (A.B., E.C., A.L. V.Z., M.A.), Hôpital Européen Georges Pompidou, Centre d'Investigation Clinique, F-75015 Paris, France; INSERM, CIC 1418 (A.B., D.B., M.A.), F-75015 Paris, France; Laboratoire de Biomathématiques, Faculté de Pharmacie (E.C.), Université Paris Descartes, Sorbonne Paris Cité, F-75005 Paris, INSERM, UMR 1144 (E.C.), F-75015 Paris, France; and Département de Physiologie-Explorations Fonctionnelles (S.B.), and Unité d'Hypertension Artérielle (L.A., G.B., P.-F.P., M.A.), Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 75015 Paris, France.
authors.forename: Aurélien
authors.initials: A
authors.lastname: Lorthioir
authors.affiliation: Department of Internal Medicine (L.N.), Centro Hospitalar São João, 4200-319 Porto, Portugal; Center for Health Technology and Services Research, Faculty of Medicine (L.N.), University of Porto, 4099-002 Porto, Portugal; Université Paris Descartes, Faculté de Médecine (A.B., A.L., V.Z., S.B., L.A., P.-F.P., J.M., M.A.), Sorbonne Paris Cité F-75006 Paris, France; Assistance Publique Hôpitaux de Paris (A.B., E.C., A.L. V.Z., M.A.), Hôpital Européen Georges Pompidou, Centre d'Investigation Clinique, F-75015 Paris, France; INSERM, CIC 1418 (A.B., D.B., M.A.), F-75015 Paris, France; Laboratoire de Biomathématiques, Faculté de Pharmacie (E.C.), Université Paris Descartes, Sorbonne Paris Cité, F-75005 Paris, INSERM, UMR 1144 (E.C.), F-75015 Paris, France; and Département de Physiologie-Explorations Fonctionnelles (S.B.), and Unité d'Hypertension Artérielle (L.A., G.B., P.-F.P., M.A.), Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 75015 Paris, France.
authors.forename: Valentina
authors.initials: V
authors.lastname: Zhygalina
authors.affiliation: Department of Internal Medicine (L.N.), Centro Hospitalar São João, 4200-319 Porto, Portugal; Center for Health Technology and Services Research, Faculty of Medicine (L.N.), University of Porto, 4099-002 Porto, Portugal; Université Paris Descartes, Faculté de Médecine (A.B., A.L., V.Z., S.B., L.A., P.-F.P., J.M., M.A.), Sorbonne Paris Cité F-75006 Paris, France; Assistance Publique Hôpitaux de Paris (A.B., E.C., A.L. V.Z., M.A.), Hôpital Européen Georges Pompidou, Centre d'Investigation Clinique, F-75015 Paris, France; INSERM, CIC 1418 (A.B., D.B., M.A.), F-75015 Paris, France; Laboratoire de Biomathématiques, Faculté de Pharmacie (E.C.), Université Paris Descartes, Sorbonne Paris Cité, F-75005 Paris, INSERM, UMR 1144 (E.C.), F-75015 Paris, France; and Département de Physiologie-Explorations Fonctionnelles (S.B.), and Unité d'Hypertension Artérielle (L.A., G.B., P.-F.P., M.A.), Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 75015 Paris, France.
authors.forename: Damien
authors.initials: D
authors.lastname: Bergerot
authors.affiliation: Department of Internal Medicine (L.N.), Centro Hospitalar São João, 4200-319 Porto, Portugal; Center for Health Technology and Services Research, Faculty of Medicine (L.N.), University of Porto, 4099-002 Porto, Portugal; Université Paris Descartes, Faculté de Médecine (A.B., A.L., V.Z., S.B., L.A., P.-F.P., J.M., M.A.), Sorbonne Paris Cité F-75006 Paris, France; Assistance Publique Hôpitaux de Paris (A.B., E.C., A.L. V.Z., M.A.), Hôpital Européen Georges Pompidou, Centre d'Investigation Clinique, F-75015 Paris, France; INSERM, CIC 1418 (A.B., D.B., M.A.), F-75015 Paris, France; Laboratoire de Biomathématiques, Faculté de Pharmacie (E.C.), Université Paris Descartes, Sorbonne Paris Cité, F-75005 Paris, INSERM, UMR 1144 (E.C.), F-75015 Paris, France; and Département de Physiologie-Explorations Fonctionnelles (S.B.), and Unité d'Hypertension Artérielle (L.A., G.B., P.-F.P., M.A.), Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 75015 Paris, France.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Baron
authors.affiliation: Department of Internal Medicine (L.N.), Centro Hospitalar São João, 4200-319 Porto, Portugal; Center for Health Technology and Services Research, Faculty of Medicine (L.N.), University of Porto, 4099-002 Porto, Portugal; Université Paris Descartes, Faculté de Médecine (A.B., A.L., V.Z., S.B., L.A., P.-F.P., J.M., M.A.), Sorbonne Paris Cité F-75006 Paris, France; Assistance Publique Hôpitaux de Paris (A.B., E.C., A.L. V.Z., M.A.), Hôpital Européen Georges Pompidou, Centre d'Investigation Clinique, F-75015 Paris, France; INSERM, CIC 1418 (A.B., D.B., M.A.), F-75015 Paris, France; Laboratoire de Biomathématiques, Faculté de Pharmacie (E.C.), Université Paris Descartes, Sorbonne Paris Cité, F-75005 Paris, INSERM, UMR 1144 (E.C.), F-75015 Paris, France; and Département de Physiologie-Explorations Fonctionnelles (S.B.), and Unité d'Hypertension Artérielle (L.A., G.B., P.-F.P., M.A.), Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 75015 Paris, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Amar
authors.affiliation: Department of Internal Medicine (L.N.), Centro Hospitalar São João, 4200-319 Porto, Portugal; Center for Health Technology and Services Research, Faculty of Medicine (L.N.), University of Porto, 4099-002 Porto, Portugal; Université Paris Descartes, Faculté de Médecine (A.B., A.L., V.Z., S.B., L.A., P.-F.P., J.M., M.A.), Sorbonne Paris Cité F-75006 Paris, France; Assistance Publique Hôpitaux de Paris (A.B., E.C., A.L. V.Z., M.A.), Hôpital Européen Georges Pompidou, Centre d'Investigation Clinique, F-75015 Paris, France; INSERM, CIC 1418 (A.B., D.B., M.A.), F-75015 Paris, France; Laboratoire de Biomathématiques, Faculté de Pharmacie (E.C.), Université Paris Descartes, Sorbonne Paris Cité, F-75005 Paris, INSERM, UMR 1144 (E.C.), F-75015 Paris, France; and Département de Physiologie-Explorations Fonctionnelles (S.B.), and Unité d'Hypertension Artérielle (L.A., G.B., P.-F.P., M.A.), Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 75015 Paris, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Bobrie
authors.affiliation: Department of Internal Medicine (L.N.), Centro Hospitalar São João, 4200-319 Porto, Portugal; Center for Health Technology and Services Research, Faculty of Medicine (L.N.), University of Porto, 4099-002 Porto, Portugal; Université Paris Descartes, Faculté de Médecine (A.B., A.L., V.Z., S.B., L.A., P.-F.P., J.M., M.A.), Sorbonne Paris Cité F-75006 Paris, France; Assistance Publique Hôpitaux de Paris (A.B., E.C., A.L. V.Z., M.A.), Hôpital Européen Georges Pompidou, Centre d'Investigation Clinique, F-75015 Paris, France; INSERM, CIC 1418 (A.B., D.B., M.A.), F-75015 Paris, France; Laboratoire de Biomathématiques, Faculté de Pharmacie (E.C.), Université Paris Descartes, Sorbonne Paris Cité, F-75005 Paris, INSERM, UMR 1144 (E.C.), F-75015 Paris, France; and Département de Physiologie-Explorations Fonctionnelles (S.B.), and Unité d'Hypertension Artérielle (L.A., G.B., P.-F.P., M.A.), Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 75015 Paris, France.
authors.forename: Pierre-François
authors.initials: PF
authors.lastname: Plouin
authors.affiliation: Department of Internal Medicine (L.N.), Centro Hospitalar São João, 4200-319 Porto, Portugal; Center for Health Technology and Services Research, Faculty of Medicine (L.N.), University of Porto, 4099-002 Porto, Portugal; Université Paris Descartes, Faculté de Médecine (A.B., A.L., V.Z., S.B., L.A., P.-F.P., J.M., M.A.), Sorbonne Paris Cité F-75006 Paris, France; Assistance Publique Hôpitaux de Paris (A.B., E.C., A.L. V.Z., M.A.), Hôpital Européen Georges Pompidou, Centre d'Investigation Clinique, F-75015 Paris, France; INSERM, CIC 1418 (A.B., D.B., M.A.), F-75015 Paris, France; Laboratoire de Biomathématiques, Faculté de Pharmacie (E.C.), Université Paris Descartes, Sorbonne Paris Cité, F-75005 Paris, INSERM, UMR 1144 (E.C.), F-75015 Paris, France; and Département de Physiologie-Explorations Fonctionnelles (S.B.), and Unité d'Hypertension Artérielle (L.A., G.B., P.-F.P., M.A.), Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 75015 Paris, France.
authors.forename: Joël
authors.initials: J
authors.lastname: Ménard
authors.affiliation: Department of Internal Medicine (L.N.), Centro Hospitalar São João, 4200-319 Porto, Portugal; Center for Health Technology and Services Research, Faculty of Medicine (L.N.), University of Porto, 4099-002 Porto, Portugal; Université Paris Descartes, Faculté de Médecine (A.B., A.L., V.Z., S.B., L.A., P.-F.P., J.M., M.A.), Sorbonne Paris Cité F-75006 Paris, France; Assistance Publique Hôpitaux de Paris (A.B., E.C., A.L. V.Z., M.A.), Hôpital Européen Georges Pompidou, Centre d'Investigation Clinique, F-75015 Paris, France; INSERM, CIC 1418 (A.B., D.B., M.A.), F-75015 Paris, France; Laboratoire de Biomathématiques, Faculté de Pharmacie (E.C.), Université Paris Descartes, Sorbonne Paris Cité, F-75005 Paris, INSERM, UMR 1144 (E.C.), F-75015 Paris, France; and Département de Physiologie-Explorations Fonctionnelles (S.B.), and Unité d'Hypertension Artérielle (L.A., G.B., P.-F.P., M.A.), Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 75015 Paris, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Azizi
mesh_terms: D000328:Adult; D000368:Aged; D001127:Arginine Vasopressin / Q000097:blood*; D003430:Cross-Sectional Studies; D000075222:Essential Hypertension; D005260:Female; D006020:Glycopeptides / Q000097:blood*; D006801:Humans; D006929:Hyperaldosteronism / Q000097:blood*; D006973:Hypertension / Q000097:blood; D008297:Male; D008875:Middle Aged; D009994:Osmolar Concentration
chemical_list: D006020:Glycopeptides; C048197:copeptins; D001127:Arginine Vasopressin