{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T15:16:05Z","timestamp":1761664565730,"version":"3.41.2"},"reference-count":31,"publisher":"The Endocrine Society","issue":"4","license":[{"start":{"date-parts":[[2023,1,27]],"date-time":"2023-01-27T00:00:00Z","timestamp":1674777600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"NIH","award":["K23 HL136262"],"award-info":[{"award-number":["K23 HL136262"]}]},{"name":"NIH","award":["R01 HL151293"],"award-info":[{"award-number":["R01 HL151293"]}]},{"name":"NIH","award":["P30 DK040561"],"award-info":[{"award-number":["P30 DK040561"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,2,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Context<\/jats:title><jats:p>The SARS-CoV-2 virus is dependent on components of the renin-angiotensin-aldosterone system for infectivity. Primary aldosteronism (PA) is a form of secondary hypertension mediated by autonomous aldosterone production. The intersection of COVID-19 and PA, both which may involve components of the renin-angiotensin-aldosterone system, remains unknown.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We assessed PA as a risk factor for COVID-19 infection and compared management, severity of disease, and outcomes during COVID-19 with a matched population of patients with essential hypertension (EH) by conducting a retrospective observational cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the patients with PA, 81 had a negative PCR test for COVID-19, whereas 43 had a documented positive PCR test for COVID-19. Those patients with PA who tested positive for COVID-19 tended to be female (P = .08) and the majority of those with COVID-19 infection identified as non-White race (P = .02) and Hispanic ethnicity (P = .02). In a subanalysis, 24-hour urine aldosterone on initial PA diagnosis tended to be higher those in the PA group who developed COVID-19 compared with those in the PA group who did not develop COVID-19 [median (interquartile range): 36.5 (16.9, 54.3) vs 22.0 (15.8, 26.8) mcg, P = .049] and was an independent predictor of COVID-19 infection controlling for sex, race, and ethnicity. Angiotensin-converting enzyme inhibitor, angiotensin II receptor blocker, and mineralocorticoid receptor antagonist use did not differ between those patients with PA who did and did not have COVID-19 infection. Comparing those patients with PA and matched patients with EH (n = 286) who were COVID-19 PCR positive, there was a significantly higher incidence of cardiovascular complications (12 vs 2%, P = .004) in the PA vs EH group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>These data begin to inform us as to whether PA should be a newly identified subpopulation at risk for COVID-19-related cardiovascular disease sequelae.<\/jats:p><\/jats:sec>","DOI":"10.1210\/jendso\/bvad015","type":"journal-article","created":{"date-parts":[[2023,1,28]],"date-time":"2023-01-28T09:10:19Z","timestamp":1674897019000},"source":"Crossref","is-referenced-by-count":1,"title":["Primary Aldosteronism and COVID-19-related Management, Disease Severity, and Outcomes: A Retrospective Cohort Study"],"prefix":"10.1210","volume":"7","author":[{"given":"Teressa S","family":"Thomas","sequence":"first","affiliation":[{"name":"Metabolism Unit, Massachusetts General Hospital and Harvard Medical School , Boston, MA 02114 , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Allie R","family":"Walpert","sequence":"additional","affiliation":[{"name":"Metabolism Unit, Massachusetts General Hospital and Harvard Medical School , Boston, MA 02114 , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Grace","family":"Shen","sequence":"additional","affiliation":[{"name":"Metabolism Unit, Massachusetts General Hospital and Harvard Medical School , Boston, MA 02114 , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carolyn","family":"Dunderdale","sequence":"additional","affiliation":[{"name":"Metabolism Unit, Massachusetts General Hospital and Harvard Medical School , Boston, MA 02114 , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1950-4770","authenticated-orcid":false,"given":"Suman","family":"Srinivasa","sequence":"additional","affiliation":[{"name":"Metabolism Unit, Massachusetts General Hospital and Harvard Medical School , Boston, MA 02114 , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"80","published-online":{"date-parts":[[2023,1,27]]},"reference":[{"issue":"1","key":"2023022120294010200_","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1186\/s12879-021-06536-3","article-title":"Mortality-related risk factors of COVID-19: a systematic review and meta-analysis of 42 studies and 423,117 patients","volume":"21","author":"Dessie","year":"2021","journal-title":"BMC Infect Dis"},{"issue":"11","key":"2023022120294010200_","doi-asserted-by":"crossref","first-page":"1436","DOI":"10.1001\/jamainternmed.2020.3596","article-title":"Factors associated with death in critically ill patients with coronavirus disease 2019 in the US","volume":"180","author":"Gupta","year":"2020","journal-title":"JAMA Intern Med"},{"issue":"5","key":"2023022120294010200_","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1016\/S2213-2600(20)30079-5","article-title":"Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study","volume":"8","author":"Yang","year":"2020","journal-title":"Lancet Respir Med"},{"issue":"3","key":"2023022120294010200_","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1016\/j.numecd.2020.12.009","article-title":"Hypertension is a clinically important risk factor for critical illness and mortality in COVID-19: a meta-analysis","volume":"31","author":"Du","year":"2021","journal-title":"Nutr Metab Cardiovasc Dis"},{"issue":"10","key":"2023022120294010200_","doi-asserted-by":"crossref","first-page":"e132","DOI":"10.1161\/HYPERTENSIONAHA.122.19694","article-title":"Hypertension and excess risk for severe COVID-19 illness despite booster vaccination","volume":"79","author":"Ebinger","year":"2022","journal-title":"Hypertension"},{"issue":"20","key":"2023022120294010200_","doi-asserted-by":"crossref","first-page":"2052","DOI":"10.1001\/jama.2020.6775","article-title":"Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York city area","volume":"323","author":"Richardson","year":"2020","journal-title":"JAMA"},{"issue":"7","key":"2023022120294010200_","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1038\/s41371-020-0336-2","article-title":"Primary aldosteronism is a public health issue: challenges and opportunities","volume":"34","author":"Libianto","year":"2020","journal-title":"J Hum Hypertens"},{"issue":"1","key":"2023022120294010200_","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/S2213-8587(17)30319-4","article-title":"Cardiovascular events and target organ damage in primary aldosteronism compared with essential hypertension: a systematic review and meta-analysis","volume":"6","author":"Monticone","year":"2018","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"26","key":"2023022120294010200_","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000015985","article-title":"Cardiovascular risk in primary aldosteronism: a systematic review and meta-analysis","volume":"98","author":"Wu","year":"2019","journal-title":"Medicine (Baltimore)"},{"issue":"3","key":"2023022120294010200_","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1161\/HYPERTENSIONAHA.117.10263","article-title":"Prevalence of cardiovascular disease and its risk factors in primary aldosteronism: a multicenter study in Japan","volume":"71","author":"Ohno","year":"2018","journal-title":"Hypertension"},{"issue":"1","key":"2023022120294010200_","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/S2213-8587(17)30367-4","article-title":"Cardiometabolic outcomes and mortality in medically treated primary aldosteronism: a retrospective cohort study","volume":"6","author":"Hundemer","year":"2018","journal-title":"Lancet Diabetes Endocrinol"},{"key":"2023022120294010200_","doi-asserted-by":"crossref","first-page":"e07","DOI":"10.15420\/ecr.2020.30","article-title":"The renin-angiotensin-aldosterone system and coronavirus disease 2019","volume":"16","author":"Coto","year":"2021","journal-title":"Eur Cardiol"},{"issue":"7","key":"2023022120294010200_","doi-asserted-by":"crossref","first-page":"1154","DOI":"10.1016\/j.ajpath.2021.04.010","article-title":"ACE2 down-regulation may act as a transient molecular disease causing RAAS dysregulation and tissue damage in the microcirculatory environment among COVID-19 patients","volume":"191","author":"Ramos","year":"2021","journal-title":"Am J Pathol"},{"issue":"5","key":"2023022120294010200_","doi-asserted-by":"crossref","first-page":"1889","DOI":"10.1210\/jc.2015-4061","article-title":"The management of primary aldosteronism: case detection, diagnosis, and treatment: an Endocrine Society clinical practice guideline","volume":"101","author":"Funder","year":"2016","journal-title":"J Clin Endocrinol Metab"},{"issue":"4","key":"2023022120294010200_","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1038\/ncpneph0151","article-title":"Primary aldosteronism: diagnostic and treatment strategies","volume":"2","author":"Mattsson","year":"2006","journal-title":"Nat Clin Pract Nephrol"},{"issue":"8","key":"2023022120294010200_","doi-asserted-by":"crossref","first-page":"1689","DOI":"10.1007\/s40618-020-01476-2","article-title":"Tele-medicine versus face-to-face consultation in endocrine outpatients clinic during COVID-19 outbreak: a single-center experience during the lockdown period","volume":"44","author":"Ceccato","year":"2021","journal-title":"J Endocrinol Invest"},{"issue":"2","key":"2023022120294010200_","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1210\/jc.2005-1733","article-title":"Prevalence and characteristics of the metabolic syndrome in primary aldosteronism","volume":"91","author":"Fallo","year":"2006","journal-title":"J Clin Endocrinol Metab"},{"issue":"1","key":"2023022120294010200_","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1093\/ajh\/hpaa137","article-title":"Aldosterone, inflammation, immune system, and hypertension","volume":"34","author":"Ferreira","year":"2021","journal-title":"Am J Hypertens"},{"issue":"1","key":"2023022120294010200_","doi-asserted-by":"crossref","first-page":"32103","DOI":"10.1038\/srep32103","article-title":"Long term outcome of aldosteronism after target treatments","volume":"6","author":"Wu","year":"2016","journal-title":"Sci Rep"},{"issue":"1","key":"2023022120294010200_","doi-asserted-by":"crossref","DOI":"10.1177\/14703203211003781","article-title":"Cardiovascular events and all-cause mortality in surgically or medically treated primary aldosteronism: a meta-analysis","volume":"22","author":"Jing","year":"2021","journal-title":"J Renin Angiotensin Aldosterone Syst"},{"key":"2023022120294010200_","doi-asserted-by":"crossref","DOI":"10.3389\/fendo.2021.644260","article-title":"Composite cardiovascular outcomes in patients with primary aldosteronism undergoing medical versus surgical treatment: a meta-analysis","volume":"12","author":"Huang","year":"2021","journal-title":"Front Endocrinol (Lausanne)"},{"issue":"11","key":"2023022120294010200_","doi-asserted-by":"crossref","first-page":"6465","DOI":"10.1016\/j.sjbs.2021.07.003","article-title":"ACE2 and COVID-19; a mechanistic review","volume":"28","author":"Elshafei","year":"2021","journal-title":"Saudi J Biol Sci"},{"issue":"3","key":"2023022120294010200_","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1093\/ajh\/hpaa169","article-title":"Serum ACE2, angiotensin II, and aldosterone levels are unchanged in patients with COVID-19","volume":"34","author":"Rieder","year":"2021","journal-title":"Am J Hypertens"},{"issue":"7","key":"2023022120294010200_","doi-asserted-by":"crossref","first-page":"2315","DOI":"10.3390\/jcm9072315","article-title":"The plasmatic aldosterone and C-reactive protein levels, and the severity of Covid-19: the Dyhor-19 study","volume":"9","author":"Villard","year":"2020","journal-title":"J Clin Med"},{"issue":"2","key":"2023022120294010200_","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1007\/s11357-021-00481-4","article-title":"The elderly at risk: aldosterone as modulator of the immune response to SARS-CoV-2 infection","volume":"44","author":"Campana","year":"2022","journal-title":"Geroscience"},{"key":"2023022120294010200_","article-title":"Molecular mechanisms lead to sex-specific COVID-19 prognosis and targeted therapies","volume":"7","author":"Galbadage","year":"2020","journal-title":"Front Med (Lausanne)"},{"issue":"10","key":"2023022120294010200_","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1007\/s11883-020-00880-6","article-title":"Effect of renin-angiotensin-aldosterone system inhibitors in patients with COVID-19: a systematic review and meta-analysis of 28,872 patients","volume":"22","author":"Baral","year":"2020","journal-title":"Curr Atheroscler Rep"},{"key":"2023022120294010200_","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.ahj.2022.01.015","article-title":"A randomized controlled trial of renin-angiotensin-aldosterone system inhibitor management in patients admitted in hospital with COVID-19","volume":"247","author":"Sharma","year":"2022","journal-title":"Am Heart J"},{"issue":"25","key":"2023022120294010200_","doi-asserted-by":"crossref","first-page":"2441","DOI":"10.1056\/NEJMoa2008975","article-title":"Renin-angiotensin-aldosterone system inhibitors and risk of Covid-19","volume":"382","author":"Reynolds","year":"2020","journal-title":"N Engl J Med"},{"issue":"1","key":"2023022120294010200_","doi-asserted-by":"crossref","first-page":"10","DOI":"10.7326\/M20-0065","article-title":"The unrecognized prevalence of primary aldosteronism: a cross-sectional study","volume":"173","author":"Brown","year":"2020","journal-title":"Ann Intern Med"},{"issue":"14","key":"2023022120294010200_","doi-asserted-by":"crossref","first-page":"1811","DOI":"10.1016\/j.jacc.2017.01.052","article-title":"Prevalence and clinical manifestations of primary aldosteronism encountered in primary care practice","volume":"69","author":"Monticone","year":"2017","journal-title":"J Am Coll Cardiol"}],"container-title":["Journal of the Endocrine Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jes\/advance-article-pdf\/doi\/10.1210\/jendso\/bvad015\/48944299\/bvad015.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jes\/article-pdf\/7\/4\/bvad015\/49284235\/bvad015.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jes\/article-pdf\/7\/4\/bvad015\/49284235\/bvad015.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,22]],"date-time":"2023-03-22T23:03:14Z","timestamp":1679526194000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jes\/article\/doi\/10.1210\/jendso\/bvad015\/7008589"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,27]]},"references-count":31,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2023,2,9]]}},"URL":"https:\/\/doi.org\/10.1210\/jendso\/bvad015","relation":{},"ISSN":["2472-1972"],"issn-type":[{"type":"electronic","value":"2472-1972"}],"subject":[],"published-other":{"date-parts":[[2023,4,1]]},"published":{"date-parts":[[2023,1,27]]},"article-number":"bvad015"}}