Effects of Mineralocorticoid Receptor Antagonists on Sex Hormones and Body Composition in Patients With Primary Aldosteronism


Mineralocorticoid receptor antagonists are frequently used for the treatment of primary aldosteronism. Steroidal mineralocorticoid receptor antagonists may have antagonistic actions on androgen receptors, agonistic actions on progesterone receptors, and antagonistic actions on mineralocorticoid receptors. Because anti-androgen effects may cause body fat accumulation and skeletal muscle atrophy, there are concerns that this drug may have adverse effects on body composition. Therefore, in this randomized prospective study, we compared the adverse effects of spironolactone, a steroidal mineralocorticoid receptor antagonist, and esaxerenone, a nonsteroidal mineralocorticoid receptor antagonist, on sex hormone levels and body composition in patients with primary aldosteronism without severe renal dysfunction. The serum concentration of free testosterone was significantly higher in the spironolactone group than in the esaxerenone group in both males and females. However, the levels of estradiol, progesterone, luteinizing hormone, and follicle stimulating hormone did not significantly increase. Changes in body fat percentage and muscle mass rate were not significantly different between the two groups. No patient showed a serum potassium level ≥6.0 mEq/L; however, serum potassium levels were significantly higher in the spironolactone group than in the esaxerenone group. These data indicate that spironolactone may have antagonistic effects on androgen receptors. Esaxerenone did not show any apparent adverse effects, suggesting that it can be safely used in patients with primary aldosteronism.

Authors: Toru Ishikawa, Satoshi Morimoto, Atsuhiro Ichihara
Keywords: sex hormones, androgen receptors, progesterone receptors, esaxerenone
DOI Number: 10.1038/s41440-021-00836-6      Publication Year: 2021

To search for other research papers by topic, keyword, author, or year, please go to our Publications page.