Endocrinology · Cardiology · Nephrology · 2 h ago
Scientific statement defines non-classical apparent mineralocorticoid excess
An Endocrine Reviews scientific statement proposes a clinical definition and diagnostic approaches for non-classical apparent mineralocorticoid excess (NC-AME), a potential contributor to low-renin hypertension. It also identifies mineralocorticoid receptor antagonists as mechanism-directed first-line therapy, while calling for diagnostic threshold standardization and multicenter validation.
- Defines NC-AME without biallelic HSD11B2 variants.
- Proposes LC-MS/MS-based and resource-adapted diagnostic approaches.
- Endorses mineralocorticoid receptor antagonists as first-line therapy.
- Calls for validation and standardized diagnostic thresholds.
A scientific statement in Endocrine Reviews addresses non-classical apparent mineralocorticoid excess (NC-AME), described as partial insufficiency of 11β-hydroxysteroid dehydrogenase type 2 without biallelic HSD11B2 variants. The statement focuses on people with low-renin hypertension, a heterogeneous group that the abstract estimates accounts for about one-third of individuals with hypertension. It proposes biochemical characterization using an elevated cortisol-to-cortisone ratio and low cortisone, alongside typically low renin, normal-to-low aldosterone, and elevated blood pressure.
The panel outlines a structured diagnostic algorithm based on liquid chromatography–tandem mass spectrometry, as well as a resource-adapted approach. It identifies genetic and epigenetic dysregulation, enzyme inhibitors, and patient factors such as age, sex, and renal function as relevant mechanistic domains. Mineralocorticoid receptor antagonists are endorsed as mechanism-directed first-line therapy, with blood pressure and renin normalization as co-primary targets.
The statement distinguishes acquired, potentially reversible causes and calls for standardized thresholds, multicenter validation, and integration into hypertension guidelines. The supplied abstract does not provide study-level patient data or details on the evidence supporting the proposed diagnostic and treatment framework; the recommendations should therefore be understood as a scientific statement rather than evidence of a validated guideline change.
In practice
For patients with hypertension and a low-renin phenotype, the statement proposes considering NC-AME when partial 11β-HSD2 insufficiency is suggested by an elevated cortisol-to-cortisone ratio and low cortisone, without biallelic HSD11B2 variants. It outlines LC-MS/MS-based and resource-adapted diagnostic approaches and endorses mineralocorticoid receptor antagonists as mechanism-directed first-line therapy, targeting blood pressure and renin normalization. These proposals come from a scientific statement; standardized thresholds, multicenter validation, and integration into hypertension guidelines remain future work, so the framework is not yet a validated guideline change.
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Endocrine Reviews: Non-Classical Apparent Mineralocorticoid Excess Syndrome: Current Evidence and Future Challenges ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.