Elevated aldosterone levels in patients with Androgenetic Alopecia

bornthisway

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Br J Dermatol. 2009 Jun 9.

Elevated aldosterone levels in patients with androgenetic alopecia

Arias-Santiago S, Gutiérrez-Salmerón MT, Castellote-Caballero L, Naranjo-Sintes R.
Dermatology Unit, San Cecilio University Hospital, Av Dr Oloriz 16, Granada 18012, Spain.

Summary Background There is reported to be an elevated prevalence of hypertension among patients with androgenetic alopecia (Androgenetic Alopecia), and it has been proposed that both phenomena may be explained by the presence of hyperaldosteronism. However, no data on aldosterone levels in patients with Androgenetic Alopecia have been published to date. Objectives The objective of this pilot study was to evaluate aldosterone levels and the presence of hypertension in patients with Androgenetic Alopecia and in healthy controls. Methods This case-control study included 40 patients with Androgenetic Alopecia and 40 healthy controls from the Dermatology Department of San Cecilio Hospital, Granada, Spain. Results Patients with Androgenetic Alopecia showed significantly higher systolic blood pressure values (136.23 vs. 124.10 mmHg, P = 0.01) and aldosterone levels (197.35 vs. 133.71 pg mL(-1), P = 0.007) vs. controls. Conclusion The elevated aldosterone values in these patients may contribute, together with other mechanisms, to the development of Androgenetic Alopecia and may also explain the higher prevalence of hypertension. Blood pressure screening of patients with Androgenetic Alopecia will permit earlier diagnosis of an unknown hypertension and initiation of appropriate treatment.

PMID: 19519833
 

JLL

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harold

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This is a very interesting study for me. From the discussion:

"This study found significantly higher systolic BP values and aldosterone levels in alopecic vs. nonalopecic individuals. Hirsso et al.1 reported a higher frequency of hypertension in Finnish male patients with Androgenetic Alopecia over 63 years old than in controls (61% vs. 45%), and a positive relationship between Androgenetic Alopecia and elevated BP values was also observed in a female population.10 Ahouansou et al. recently studied 250 men aged 35–65 years and detected alopecia in 82% of hypertensive patients (>140/90 mmHg) vs. 56% of normotensive patients (P < 0·001).7 Two explanations have been proposed for this association. One is that androgens involved in Androgenetic Alopecia pathogenesis bind to blood vessel receptors, favouring a BP increase, and the other is that the hyperaldosteronism present in the majority of hypertensive patients directly participates in the development of alopecia. In relation to the former hypothesis, the present study found very similar testosterone values between the groups; therefore the elevated BP values in the patients with Androgenetic Alopecia could be explained by an increase in peripheral sensitivity to androgens. The second hypothesis is consistent with the development of alopecia in transgenic mice with cutaneous overexpression of mineralocorticoid receptors.9 It is also supported by the present finding of higher aldosterone values in hypertensive patients with Androgenetic Alopecia than in hypertensive controls. Hence, elevated aldosterone values may participate alongside other factors in the development of alopecia, which would explain the higher prevalence of hypertension in patients with Androgenetic Alopecia."

As the authors mention spironolactone can reduce aldosterone levels and helps in Androgenetic Alopecia but is obviously an antiandrogen. I dont know that there are any other drugs that effect aldosterone.
hh
 

harold

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The question is I guess does the elevation in aldosterone play a causative role in hair loss or is it perhaps another symptom of higher androgen levels. The authors of the above study do quote another study in which mice which were created to overexpress the mineralcorticoid receptor displayed alopecia and also note that although there were serum differences in aldosterone between the bald and non-bald patients there were no serum testosterone differences. The abstract below may indicate that high aldosterone values are another symptom of men wth very high conversion of T to DHT as the stimulatory effects of DHT on aldosterone secretion where not blocked by flutamide (though they did not use hydroxyflutamide). If it was a case of DHT -> aldosterone -> Androgenetic Alopecia then we would expect that flutamide and other pure antiandrogens wouldnt be effective at stopping hair loss in humans based on the result here that flutamide didnt seem to interfere with DHTs increase in aldosterone synthesis. Though the use of flutamide over hydroxyflutamide may make this result questionable (its been a while and i cant really remember the binding efficacies of antiandrogens but IIRC flutamide is a pretty lusy antiandogen before being converted in the liver to hydroxyflutamide).


Dihydrotestosterone stimulates aldosterone secretion by H295R human adrenocortical cells
Auteur(s) / Author(s)
YANES Licy L. ; ROMERO Damian G. ;
Résumé / Abstract
Men exhibit a higher incidence of cardiovascular diseases than do women. The cardiovascular actions of sex steroids have been suggested as primary factors in mediating this sex difference. The mechanisms by which sex steroids, androgens and estrogens, mediate cardiovascular actions remain unclear. Excess aldosterone secretion has been associated with cardiovascular diseases. The hypothesis tested in this study was that at physiological concentrations, androgens stimulate and estradiol inhibits aldosterone secretion by human adrenal cells. In contrast to our hypothesis, physiological concentrations of sex steroids did not modify aldosterone secretion by H295R human adrenocortical cells. However, supraphysiological concentrations (300-1000 nM) of dihydrotestosterone (DHT) significantly stimulated basal and Angiotensin II-mediated aldosterone secretion. The stimulatory effect of DHT on aldosterone secretion was not blocked by the classical androgen receptor blocker flutamide. The stimulatory effect of DHT on aldosterone secretion was also independent of the intra-adrenal renin-angiotensin system since it was neither modified by treatment with the Angiotensin II receptor type 1 blocker losartan or the angiotensin converting enzyme inhibitor captopril. Inhibitors of the calmodulin/calmodulin-dependent protein kinase (CaMK) and protein kinase C intracellular signaling pathways abolished the DHT stimulatory effect on aldosterone secretion by H295R cells. In conclusion, physiological concentrations of sex steroids did not modify aldosterone secretion by human adrenal cells. However, supraphysiological concentrations of DHT-stimulated aldosterone secretion by human adrenal cells by the calmodulin/CaMK and protein kinase C intracellular signaling pathways but independently of the classical androgen receptor. Supraphysiological doses of androgen may promote cardiovascular diseases via stimulation of aldosterone secretion.
 

harold

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Elevated aldosterone also found in balding women.

Br J Dermatol. 2009 Nov 10. [Epub ahead of print]

HYPERTENSION AND ALDOSTERONE LEVELS IN WOMEN WITH EARLY-ONSET ANDROGENETIC ALOPECIA.
Arias-Santiago S, Guiérrez-Salmerón MT, Buendía-Eisman A, Girón-Prieto MS, Naranjo-Sintes R.

San Cecilio University Hospital, Department of Dermatology, Av Dr Oloriz 16, Granada 18012, Spain.

Background Few studies have analyzed the relationship between androgenetic alopecia in women and cardiovascular disease. There is reported to be an elevated prevalence of hypertension among men with androgenetic alopecia (Androgenetic Alopecia), and it has been proposed that both phenomena may be explained by the presence of hyperaldosteronism. However, no data on blood pressure (BP) and aldosterone levels in women with Androgenetic Alopecia have been published to date. Objective The objective of this study was to evaluate aldosterone levels and the presence of systolic and diastolic hypertension in women with early-onset Androgenetic Alopecia and in healthy controls. Methods This case-control study included 40 women with Androgenetic Alopecia and 40 healthy controls from the Dermatology Department of San Cecilio Hospital, Granada (Spain). Results Androgenetic Alopecia patients showed significantly higher systolic BP values (139.43 vs. 107.80 mmHg P<0.0001), diastolic BP values (87.65 vs. 67.48 mmHg P<0.0001) and aldosterone levels (249.55 vs. 155.14 pg/ml; P=0.002) versus controls respectively. A positive correlation between aldosterone levels and systolic and diastolic BP values is described. Conclusion A higher prevalence of hypertension in women with androgenetic alopecia has been found. The elevated aldosterone values in these patients may contribute, alongside other mechanisms, to the development of Androgenetic Alopecia and may also explain the higher prevalence of hypertension. Blood pressure screening of women with Androgenetic Alopecia will permit earlier diagnosis of an unsuspected hypertension and initiation of appropriate treatment.
 
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