Medical Treatment for Primary Aldosteronism Healed Intractable Leg Ulcer : Involvement of Aldosterone in the Dermatological Disease

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SAT 53-73-Primary Aldosteronism & Mineralocorticoid Excess
Clinical
Saturday, June 15, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SAT-68
Isao Kurihara*, Hirotaka Shibata, Kazutoshi Miyashita, Hideyo Oguchi, Kenichi Yokota, Ayano Murai-Takeda, Yuko Mitsuishi, Rie Jo, Takako Ohyama, Toshifumi Nakamura, Akiko Tanikawa and Hiroshi Itoh
School of Medicine, Keio University, Tokyo, Japan
[Introduction] A large number of basic and clinical researches have been demonstrating the pro-inflammatory effects of aldosterone. Aldosterone plays a crucial role in the pathogenesis of cardiovascular diseases, which is accompanied by elevation of several inflammatory biomarkers, such as TNF-α, MCP, CRP, and PAI-1. These aldosterone actions mostly go through mineralocorticoid receptor (MR); therefore, the MR blockade could effectively alleviate these complications. Primary aldosteronism (PA) is thoroughly chased and commonly diagnosed recently because of prevailing awareness of its poor prognosis. Cardio-renoprotective effects of MR antagonist have been well-documented, but the benefit for skin disease was rarely discussed. Here we report an impressive case where MR antagonist was truly effective to induce cure for intractable leg ulcer.

[Clinical Case] A 54-year-old man primarily visited a dermatologist 2 years ago because an egg-sized ulcer lesion emerged on his left leg. He was obese (BMI 27.3) and had history of hypertension for more than 10 years, but no history of diabetes mellitus. Screening of markers for collagen disease and coagulopathy was all negative, and CT angiography image in his lower extremities revealed no obstructive or stenotic vascular lesion. Livedo vasculitis was suspected and 30 mg/day PSL was initiated, but new ulcer lesions emerged and were progressively expanded. His blood pressure (BP) was poorly controlled on multi-antihypertensive drugs; therefore, he was consulted to our department for endocrinological evaluation. Active renin concentration was 2.1 pg/mL and serum aldosterone level was 110 pg/mL, indicating screening-positive for PA.  The 24-h urinary aldosterone under salt-loading test was extremely high (31.4 μg) and other confirmatory tests also led to diagnosis as PA. Abdominal CT image revealed a low-density mass in the left adrenal, but the patient chose medication as treatment for PA, so we started 100 mg/day eplerenone. Months later his leg ulcer lesions strikingly got reduced in size concomitantly with better BP control, and epithelialization are mostly completed in the current status.

[Discussion] This type of skin ulcer was originally reported as “arteriosclerotic ulcer of Martorell” in 1945. The underlying mechanism is supposed to be arterial ischemia caused by uncontrolled severe hypertension and lifestyle-related diseases. Although it is not conclusive whether MR blockade or BP control contributes to disappearance of skin lesion, MR antagonist was notably effective to heal the intractable skin lesion. This case suggests the potential benefit of MR antagonism on ulcerative skin disease such as peripheral artery disease (PAD) and diabetic gangrene.

Nothing to Disclose: IK, HS, KM, HO, KY, AM, YM, RJ, TO, TN, AT, HI

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm