Autonomous Aldosterone Secretion in Patients with Adrenal Incidentaloma
, Ewa Zalewska 1, Katarzyna Kunicka 2, Ewa Świerblewska 2 and Krzysztof Sworczak 1Round 1
Reviewer 1 Report
Thank you for the opportunity to review manuscript entitled ‘Autonomous Aldosterone Secretion In Patients with Adrenal Incidentalomas’ by Piotr Kmieć and co-authors.
In the present study, authors investigated the prevalence of autonomous aldosterone secretion defined as positive Ald-to-renin ratio combined with unsuppressed Ald, and its associations with blood pressure and several of other parameters. This problem is very relevant due to the growing need to expand the number of minimally invasive research methods for examining patients with this pathology.
The authors well described the research methods and criteria for selecting patients. Kmieć and co-authors objectively assess the limitations of their study and the difficulties they encountered in this study. The manuscript is well written and easy to understand. It provides relevant and valuable information which appropriate for publication in Biomedicines journal.
Author Response
Point 1. The authors well described the research methods and criteria for selecting patients. Kmieć and co-authors objectively assess the limitations of their study and the difficulties they encountered in this study. The manuscript is well written and easy to understand. It provides relevant and valuable information which appropriate for publication in Biomedicines journal.
Response 1: We thank Reviewer 2 for recommending publication of the manuscript.
Reviewer 2 Report
Remarks to the author:
In this study Kmieć et al evaluated the prevalence of autonomous aldosterone secretion and its associations with blood pressure, cardiac function, and common carotid artery intima-media thickness in patients with incidentally discovered adrenal adenomas. There were 63 participants with adrenal incidentalomas included into the study and those patients were either normotensive or hypertensive but had no other cardiovascular diseases. The patents underwent hormonal examinations, BP measurement, transthoracic echocardiography, and common carotid artery intima-media thickness assessment without altering their chronic medications (eg: RAAS-interfering medications). According to the results, a relatively high prevalence of autonomous aldosterone excess among patients with adrenal adenomas/hyperplasia was detected. In authors' view, detection of autonomous aldosterone secretion is an important approach in patients with adrenal adenomas.
Specific comments:
1. Material and methods:
i) Although the authors have used to the standard methods, they need to justify the reasons for using each method for their study.
ii) It would be better if authors could explain each method separately (eg: with subtopics) rather than providing methods as a single section. It would be more interesting for the reader to go through.
2. Discussion and Conclusion:
i) As most of the patients with AI are females in this study, it is interesting to know whether there is any correlation between female hormones and occurrence of AI. Do the authors have evidence to prove whether there is any relation or not which will be useful to consider in screening for primary aldosteronism in male and female patients.
Thank you.
Author Response
Point 1. Material and methods: i) Although the authors have used to the standard methods, they need to justify the reasons for using each method for their study.
Response 1: We provided justification of the methods applied in the study in lines 91-95 of the revised version of the manuscript. Literature reviews have been cited in this section to reference associations between excess aldosterone secretion and: hypertension, atherosclerosis, metabolic syndrome, as well as cardiac remodeling.
Point 2. Material and methods:ii) It would be better if authors could explain each method separately (eg: with subtopics) rather than providing methods as a single section. It would be more interesting for the reader to go through.
Response 2: The revised version of the manuscript includes six subsections within 'Methods'.
Point 3. Discussion and Conclusion: i) As most of the patients with AI are females in this study, it is interesting to know whether there is any correlation between female hormones and occurrence of AI. Do the authors have evidence to prove whether there is any relation or not which will be useful to consider in screening for primary aldosteronism in male and female patients.
Response 3: Among 63 AI patients recruited in our study, there were 44 women and 19 men. This proportion contrasts with (almost) equal AI prevalence between sexes reported in literature (e.g. Bancos and Prete, Approach to the Patient With Adrenal Incidentaloma, J Clin Endocrinol Metab. 2021 Nov; 106(11): 3331–3353). However, hormonal testing can be performed also in an ambulatory setting, which perhaps men prefer. Another reason for the discrepancy was that male patients more frequently met exclusion criteria of the study than female (e.g. had overt cardiovascular disease, declined participation, etc).
We do not believe our results provide basis to approach PA screening differently between men and women. It is probable, however, AAS (or mild PA) contributes to earlier occurrence of cardiovascular disease in men than in women owing to the protective effect of hormones prior to menopause (normotensive PA is more common in women). Therefore, by the time men reach the age when AI are more prevalent, few patients can be found without cardiovascular complications.
