Evidence-Based Hormone Therapies

Healthy men

Healthy men: IV aldosterone produces acute cardiovascular (sympathetic) effects (first 45 min after injection) and delayed (5 ½ – 6 ½ h after) increased vagal tone (parasympathetic predominance) (1 reference)

1. 1.Schmidt BM1, Montealegre A, Janson CP, Martin N, Stein-Kemmesies C, Scherhag A, Feuring M, Christ M, Wehling M. Short term cardiovascular effects of aldosterone in healthy male volunteers. J Clin Endocrinol Metab. 1999 Oct;84(10):3528-33.

Healthy men: Aldosterone at 100 µg, tending to increase cardiac vagal activity and enhances the heart rate (tachycardia) response to diastolic blood pressure-reducing nitroprusside (1 reference)

2. Heindl S, Holzschneider J, Hinz A, Sayk F, Fehm HL, Dodt C. Acute effects of aldosterone on the autonomic nervous system and the baroreflex function in healthy humans. J Neuroendocrinol. 2006 Feb;18(2):115-21.

Healthy men: Aldosterone at 3 µg /min. rapidly impairs the baroreflex response (1 reference)

3. Schmidt BM, Horisberger K, Feuring M, Schultz A, Wehling M. Aldosterone blunts human baroreflex sensitivity by a nongenomic mechanism. Exp Clin Endocrinol Diabetes. 2005 May;113(5):252-6. (tachycardic response to arterial baroreceptor deactivation was more pronounced in the aldosterone experiments

Healthy men: Aldosterone (+7.6%) increases blood flow by increasing NO release and at the vascular smooth muscle cells by promoting vasoconstriction of forearm arteries (2 references)

4. Romagni P, Rossi F, Guerrini L, Quirini C, Santiemma V. Aldosterone induces contraction of the resistance arteries in man. 2003 Feb;166(2):345-9.
5. Schmidt BM, Oehmer S, Delles C, Bratke R, Schneider MP, Klingbeil A, Fleischmann EH, Schmieder RE. Rapid nongenomic effects of aldosterone on human forearm vasculature. 2003 Aug;42(2):156-60.

Healthy men: Aldosterone increases phosphocreatine recovery in muscles to significantly higher levels immediately after isometric contraction within 8 min of aldosterone administration (2 references)

6. Zange J, Müller K, Gerzer R, Sippel K, Wehling M. Nongenomic effects of aldosterone on phosphocreatine levels in human calf muscle during recovery from exercise. J Clin Endocrinol Metab. 1996 Dec;81(12):4296-300.
7. Christ M1, Zange J, Janson CP, Müller K, Kuklinski P, Schmidt BM, Tillmann HC, Gerzer R, Wehling M. Hypoxia modulates rapid effects of aldosterone on oxidative metabolism in human calf muscle. J Endocrinol Invest. 2001 Sep;24(8):587-97.

Healthy men: IV aldosterone at 500 µg (pharmacological dose) slightly reduces glomerular filtration rate and with inhibition of nitric oxide synthase reduces renal blood flow, triggering a mechanism for increases in blood pressure (1 reference)

8. Schmidt BM, Sammer U, Fleischmann I, Schlaich M, Delles C, Schmieder RE. Rapid nongenomic effects of aldosterone on the renal vasculature in humans. 2006 Apr;47(4):650-5.

Healthy men: Aldosterone reduces the excretion of sodium and chloride and increases excretion of potassium and (net) acid in the urine (1 reference)

9. Lemann J Jr, Piering WF, Lennon EJ. Studies of the acute effects of aldosterone and cortisol on the interrelationship between renal sodium, calcium and magnesium excretion in normal man. 1970;7(2):117-30.

Healthy men: no obvious effect on sleep of aldosterone (1 reference)

10. Born J1, Zwick A, Roth G, Fehm-Wolfsdorf G, Fehm HL. Differential effects of hydrocortisone, fluocortolone, and aldosterone on nocturnal sleep in humans. Acta Endocrinol (Copenh). 1987 Sep;116(1):129-37.

Patients with disease

Orthostatic hypotension: Aldosterone reduces orthostatism (1 reference)

11. Ditzel J, Hansen PH, Kemp E, Lindbjerg IF. Effect of aldosterone on orthostatic circulatory failure. Acta Med Scand. 1964 Jun;175:673-80.

Suspected coronary heart disease: IV aldosterone at a supraphysiological dose (1 mg) increases systemic vascular resistance, cardiac output, and cardiac index within 3 minutes, the effect disappeared within 10 min. (1 reference)

12. Wehling M1, Spes CH, Win N, Janson CP, Schmidt BM, Theisen K, Christ M. Rapid cardiovascular action of aldosterone in man. J Clin Endocrinol Metab. 1998 Oct;83(10):3517-22.

Supraventricular arrhythmias: IV aldosterone increases monophasic action potential duration within minutes in patients (1 reference)

13. Tillmann HC1, Schumacher B, Yasenyev O, Junker M, Christ M, Feuring M, Wehling M. Acute effects of aldosterone on intracardiac monophasic action potentials. Int J Cardiol. 2002 Jul;84(1):33-9

Healthy adults

Young healthy women: Fludrocortisone treatment produces significant suppression of CRH secretion, trend to significant reduction of secretion of ACTH and cortisol secretion from dose 75 µg/day on (1 reference)

1. Karamouzis I, Berardelli R, Marinazzo E, D’Angelo V, Zinnà D, Minetto MA, Zichi C, Fussotto B, Giordano R, Ghigo E, Arvat E. The acute effect of fludrocortisone on basal and hCRH-stimulated hypothalamic–pituitary—adrenal (HPA) axis in humans. Pituitary. 2013 Sep;16(3):378-85.

Healthy adults: Fludrocortisone treatment produces significant effects on pituitary- adrenal axias, arterial tone and intestinal sodium excretion (4 references)

2. Laviolle B, Donal E, Le Maguet P, Lainé F, Bellissant E. Low doses of fludrocortisone and hydrocortisone, alone or in combination, on vascular responsiveness to phenylephrine in healthy volunteers. Br J Clin Pharmacol. 2013 Feb;75(2):423-30.
3. Mion D Jr, Rea RF, Anderson EA, Kahn D, Sinkey CA, Mark AL. Effects of fludrocortisone on sympathetic nerve activity in humans. Hypertension. 1994 Jan;23(1):123-30.
4. Otte C, Jahn H, Yassouridis A, Arlt J, Stober N, Maass P, Wiedemann K, Kellner M. The mineralocorticoid receptor agonist, fludrocortisone, inhibits pituitary-adrenal activity in humans after pre-treatment with metyrapone. Life Sci. 2003 Aug 22;73(14):1835-45.
5. Wenzl HH, Fine KD, Santa Ana CA, Porter JL, Fordtran JS. Effect of fludrocortisone and spironolactone on sodium and potassium losses in secretory diarrhea. Dig Dis Sci. 1997 Jan;42(1):119-28.

Aldosterone deficiency: Fludrocortisone produces significantly beneficial effects (1 reference)

6. Laviolle B, Le Maguet P, Verdier MC, Massart C, Donal E, Lainé F, Lavenu A, Pape D, Bellissant E. Biological and hemodynamic effects of low doses of fludrocortisone and hydrocortisone, alone or in combination, in healthy volunteers with hypoaldosteronism. Clin Pharmacol Ther. 2010 Aug;88(2):183-90.

Orthostatic hypotension: Fludrocortisone significantly reduces orthostatic hypotension in patients (1 reference)

7. Finke J, Sagemüller I. Fludrocortisone in the treatment of orthostatic hypotension: ophthalmodynamography during standing. Dtsch Med Wochenschr. 1975 Sep 5;100(36):1790-2.

Vasovagal syncope: Fludrocortisone significantly reduced the likelihood of syncope in patients (1 reference)

8. Sheldon R, Raj SR, Rose MS, Morillo CA, Krahn AD, Medina E, Talajic M, Kus T, Seifer CM, Lelonek M, Klingenheben T, Parkash R, Ritchie D, McRae M; POST 2 Investigators.. Fludrocortisone for the prevention of vasovagal syncope: a randomized, placebo-controlled trial. J Am Coll Cardiol. 2016 Jul 5;68(1):1-9.

Orthostatic hypotension: Fludrocortisone does not  prevent orthostatic hypotension after space flight (1 reference)

9. Shi SJ, South DA, Meck JV. Fludrocortisone does not prevent orthostatic hypotension in astronauts after spaceflight. Aviat Space Environ Med. 2004 Mar;75(3):235-9.

Chronic fatigue syndrome: Fludrocortisone associated to hydrocortisone at very low doses does not significantly reduces fatigue (1 reference)

10. Blockmans D, Persoons P, Van Houdenhove B, Lejeune M, Bobbaers H. Combination therapy with hydrocortisone and fludrocortisone does not improve symptoms in chronic fatigue syndrome: a randomized, placebo-controlled, double-blind, crossover study. Am J Med. 2003 Jun 15;114(9):736-41.

Chronic fatigue syndrome: Fludrocortisone alone does not significantly improve CFS symptoms (2 references)

11. Rowe PC, Calkins H, DeBusk K, McKenzie R, Anand R, Sharma G, Cuccherini BA, Soto N, Hohman P, Snader S, Lucas KE, Wolff M, Straus SE. Fludrocortisone acetate to treat neurally mediated hypotension in chronic fatigue syndrome: a randomized controlled trial. JAMA. 2001 Jan 3;285(1):52-9.
12. Peterson PK, Pheley A, Schroeppel J, Schenck C, Marshall P, Kind A, Haugland JM, Lambrecht LJ, Swan S, Goldsmith S. A preliminary placebo-controlled crossover trial of fludrocortisone for chronic fatigue syndrome. Arch Intern Med. 1998 Apr  27;158(8):908-14.

Borderline personality disorder: Fludrocortisone at supraphysiological doses (400 µg/day) improves memory (cognitive function: verbal, visuospatial and working memory), in healthy subjects only working memory (1 reference)

13. Wingenfeld K, Kuehl LK, Janke K, Hinkelmann K, Eckert FC, Roepke S, Otte C. Effects of mineralocorticoid receptor stimulation via fludrocortisone on memory in women with borderline personality disorder. Neurobiol Learn Mem. 2015 Apr;120:94-100.

Borderline personality and major depressive disorders, healthy subjects: No effect of fludrocortisone on autobiographical memory (1 reference)

14. Fleischer J, Wingenfeld K, Kuehl LK, Hinkelmann K, Roepke S, Otte C. Does fludrocortisone influence autobiographical memory retrieval? A study in patients with major depression, patients with borderline personality disorder and healthy controls. Stress. 2015;18(6):718-22.

Severe traumatic brain injury: Fludrocortisone associated to hydrocortisone at low doses does not significantly prevent hospital-acquired pneumonia (1 reference)

15. Asehnoune K, Seguin P, Allary J, Feuillet F, Lasocki S, Cook F, Floch H, Chabanne R, Geeraerts T, Roger C, Perrigault PF, Hanouz JL, Lukaszewicz AC, Biais M, Boucheix P, Dahyot-Fizelier C, Capdevila X, Mahe PJ, Le Maguet P, Paugam-Burtz C, Gergaud S, Plaud B, Constantin JM, Malledant Y, Flet L, Sebille V, Roquilly A; Corti-TC Study Group. Hydrocortisone and fludrocortisone for prevention of hospital-acquired pneumonia in patients with severe traumatic brain injury (Corti-TC): a double-blind, multicentre phase 3, randomized placebo-controlled trial. Lancet Respir Med. 2014 Sep;2(9):706-16

Septic shock: Fludrocortisone associated to hydrocortisone at low doses produces beneficial effects, including better renal function (1 reference)

16. Laviolle B, Annane D, Fougerou C, Bellissant E. Gluco- and mineralocorticoid biological effects of a 7-day treatment with low doses of hydrocortisone and fludrocortisone in septic shock. Intensive Care Med. 2012 Aug;38(8):1306-14.

Septic shock: Fludrocortisone associated to hydrocortisone at low doses reduces mortality (1 reference)

17. Annane D, Sébille V, Charpentier C, Bollaert PE, François B, Korach JM, Capellier G, Cohen Y, Azoulay E, Troché G, Chaumet-Riffaud P, Bellissant E. Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA. 2002 Aug 21;288(7):862-71. Erratum in: JAMA. 2008 Oct 8;300(14):1652.

Children

Children with syncope or severe presyncope: Fludrocortisone: produces significant beneficial effects to reduce syncopal symptoms; including syncope (2 references)

18. Salim MA, Di Sessa TG. Effectiveness of fludrocortisone and salt in preventing syncope recurrence in children: a double-blind, placebo-controlled, randomized trial. J Am Coll Cardiol. 2005 Feb 15;45(4):484-8.
19. Scott WA, Pongiglione G, Bromberg BI, Schaffer MS, Deal BJ, Fish FA, Dick M. Randomized comparison of atenolol and fludrocortisone acetate in the treatment of pediatric neurally mediated syncope. Am J Cardiol. 1995 Aug 15;76(5):400-2

Atherosclerosis: the association with lower aldosterone to renin ratio in the serum (1 reference)

1. Lee MY, Lai WT. Plasma renin level and aldosterone to renin ratio are associated with presence of carotid plaques in patients with stable coronary artery disease. J Renin Angiotensin Aldosterone Syst. 2015 Dec;16(4):1159-67.

Atherosclerosis: the association with higher serum aldosterone levels (1 reference)

1. Zhang S, Wang N, Chen L, Zhang P, Shen L, Huang S, Zhang C, Deng B. Serum Aldosterone Is Associated with Cerebral Artery Atherosclerosis and Calcification. J Stroke Cerebrovasc Dis. 2018 Dec 8, pii: S1052-3057(18)30575-5.

Atherosclerosis: the association with higher aldosterone to renin ratio in the serum (1 reference)

1. Loureiro C, Campino C, Martinez-Aguayo A, Godoy I, Aglony M, Bancalari R, Garcia H, Carvajal CA, Fardella C. Positive association between aldosterone-renin ratio and carotid intima-media thickness in hypertensive children. Clin Endocrinol (Oxf). 2013 Mar;78(3):352-7.

Dehydration caused by hypotremia and pollakiuria: the improvement with fludrocortisone (3 references)

1. Celik US, Alabaz D, Yildizdas D, Alhan E, Kocabas E, Ulutan S. Cerebral salt wasting in tuberculous meningitis: treatment with fludrocortisone. Ann Trop Paediatr. 2005 Dec;25(4):297-302
2. Tieder M, Vure E, Gulboa Y, Rosenberg T, Modai D. Salt-losing syndrome in newborn infants with hyperaldosteronism. Presenting a sensitivity to mineralocorticoids. Pseudohypoaldosteronism. Arch Fr Pediatr. 1976 May;33(5):485-96
3. Wenzl HH, Fine KD, Santa Ana CA, Porter JL, Fordtran JS. Effect of fludrocortisone and spironolactone on sodium and potassium losses in secretory diarrhea. Dig Dis Sci. 1997 Jan;42(1):119-28

Thirsty (polydipsia) the association with lower aldosterone levels (2 references)

1. Broughton A. Clinical value of 24-hour urine hormone evaluations.Townsend Letter for Doctors and Patients, 2004Jan
2. Aldosterone reduces urine output of sodium and fluid. Aldosterone deficiency is accompanied by excessive sodium and urine output, which increases thirst. Spironolactone administration mimicks aldosterone deficiency by blocking aldosterone by blocking the aldosterone receptors in the kidneys and increases, urine output.

Polyuria, pollakiuria: the association with lower aldosterone levels (4 references)

1. Ozdemir H, Aycan Z, Degerliyurt A, Metin A. The treatment of cerebral salt wasting with fludrocortisone in a child with lissencephaly. Turk Neurosurg. 2010 Jan;20(1):100-2
2. Celik US, Alabaz D, Yildizdas D, Alhan E, Kocabas E, Ulutan S. Cerebral salt wasting in tuberculous meningitis: treatment with fludrocortisone. Ann Trop Paediatr. 2005 Dec;25(4):297-302
3. Lambert PP, Verniory A. Sensitivity to aldosterone of polyuria and Salt-losing observed during an anuric episode. J Urol Nephrol (Paris). 1963 Oct-Nov;69:628-31
4. Dingman JF, Despointes RH, Laidlaw JC, Thorn GW. Studies of neurohypophyseal function in man: effect of adrenal steroids on polyuria in combined anterior and posterior pituitary insufficiency. J Lab Clin Med. 1958 May;51(5):690-700

Orthostatic hypotension, tachycardia, hypovolemia: the association with low aldosterone levels (3 references)

1. Jacob G, Robertson D, Mosqueda-Garcia R, Ertl AC, Robertson RM, Biaggioni I. Hypovolemia in syncope and orthostatic intolerance role of the renin-angiotensin system. Am J Med. 1997 Aug;103(2):128-33
2. Grenon SM, Hurwitz S, Sheynberg N, Xiao X, Ramsdell CD, Mai CL, Kim C, Cohen RJ, Williams GH. Role of individual predisposition in orthostatic intolerance before and after simulated microgravity. J Appl Physiol. 2004 May;96(5):1714-22
3. Uchiyama M, Otsuka T, Shibuya Y, Sakai K. Abnormal sodium and potassium metabolism in orthostatic dysregulation in childhood. Tohoku J Exp Med. 1984 Nov;144(3):327-8.

Arterial hypotension, dehydration and postural dizziness: the improvement with fludrocortisone treatment (16 references)

1. Huang WT, Chau T, Wu ST, Lin SH. Prolonged hyperkalemia following unilateral adrenalectomy for primary hyperaldosteronism. Clin Nephrol. 2010 May;73(5):392-7.
2. Jacob G, Robertson D, Mosqueda-Garcia R, Ertl AC, Robertson RM, Biaggioni I. Hypovolemia in syncope and orthostatic intolerance role of the renin-angiotensin system. Am J Med. 1997 Aug;103(2):128-33
3. Grenon SM, Hurwitz S, Sheynberg N, Xiao X, Ramsdell CD, Mai CL, Kim C, Cohen RJ, Williams GH. Role of individual predisposition in orthostatic intolerance before and after simulated microgravity. J Appl Physiol. 2004 May;96(5):1714-22
4. Uchiyama M, Otsuka T, Shibuya Y, Sakai K. Abnormal sodium and potassium metabolism in orthostatic dysregulation in childhood. Tohoku J Exp Med. 1984 Nov;144(3):327-8.
5. Schoffer KL, Henderson RD, O’Maley K, O’Sullivan JD. Nonpharmacological treatment, fludrocortisone, and domperidone for orthostatic hypotension in Parkinson’s disease. Mov Disord. 2007 Aug 15;22(11):1543-9

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Hypotension: the improvement with fludrocortisone intake (2 references)

1. Seo Y, Jeung S, Kang SM, Yang WS, Kim H, Kim SB. Use of fludrocortisone for intradialytic hypotension. Kidney Res Clin Pract. 2018 Mar;37(1):85-88.
2. Rizk M, El Khatib M, Yamout B, Hujeily E, Ayoub S, Ayoub C, Skaf G. Spontaneous intracranial hypotension syndrome treated with fludrocortisone. A A Case Rep. 2015 Jan 1;4(1):8-11.

Hypertension : the association with lower aldosterone levels in hypertensive patients (1 reference)

1. Cho JS, Ihm SH, Jang SW, Chung WB, Choi YS, Shin DI, Seo SM, Park MW, Kim GH, Her SH, Kim CJ, Kim TH, Kang MK, Chang K, Park CS. Negative association between plasma aldosterone concentration/plasma renin activity and morning blood pressure surge in never-treated hypertensive patients. Clin Exp Hypertens. 2014;36(4):195-9.

Hypertension: the association with higher aldosterone levels (3 references)

1. Zitouni H, Raguema N, Gannoun MBA, Hebert-Stutter M, Zouari I, Maleh W, Faleh R, Letaifa DB, Almawi WY, Fournier T, Mahjoub T, Guibourdenche J. Impact of obesity on the association of active renin and plasma aldosterone concentrations, and aldosterone-to-renin ratio with preeclampsia. Pregnancy Hypertens. 2018 Oct;14:139-144.
2. Bonfig W, Schwarz HP. Blood pressure, fludrocortisone dose and plasma renin activity in children with classic congenital adrenal hyperplasia due to 21-hydroxylase deficiency followed from birth to 4 years of age. Clin Endocrinol (Oxf). 2014 Dec;81(6):871-5.
3. Kidambi S, Kotchen JM, Krishnaswami S, Grim CE, Kotchen TA. Aldosterone contributes to blood pressure variance and to likelihood of hypertension in normal-weight and overweight African Americans. Am J Hypertens. 2009 Dec;22(12):1303-8.

Obesity: the association with high aldosterone levels (9 references)

1. Laffin LJ, Majewski C, Liao C, Bakris GL. Relationship Between Obesity, Hypertension, and Aldosterone Production in Postmenopausal African American Women: A Pilot Study. J Clin Hypertens (Greenwich). 2016 Dec;18(12):1216-1221.
2. Chiang JK, Chen CL, Tseng FY, Chi YC, Huang KC, Yang WS. Higher blood aldosterone level in metabolic syndrome is independently related to adiposity and fasting plasma glucose. Cardiovasc Diabetol. 2015 Jan 13;14:3.
3. Barceló A, Piérola J, Esquinas C, de la Peña M, Arqué M, Alonso-Fernández A, Bauçà JM, Robles J, Barceló B, Barbé F. Relationship between aldosterone and the metabolic syndrome in patients with obstructive sleep apnea-hypopnea syndrome: effect of continuous positive airway pressure treatment. PLoS One. 2014 Jan 20;9(1):e84362.
4. Musani SK, Vasan RS, Bidulescu A, Liu J, Xanthakis V, Sims M, Gawalapu RK, Samdarshi TE, Steffes M, Taylor HA, Fox ER. Aldosterone, C-reactive protein, and plasma B-type natriuretic peptide are associated with the development of metabolic syndrome and longitudinal changes in metabolic syndrome components: findings from the Jackson Heart Study. Diabetes Care. 2013 Oct;36(10):3084-92.
5. Cooper JN, Fried L, Tepper P, Barinas-Mitchell E, Conroy MB, Evans RW, Mori Brooks M, Woodard GA, Sutton-Tyrrell K. Changes in serum aldosterone are associated with changes in obesity-related factors in normotensive overweight and obese young adults. Hypertens Res. 2013 Oct;36(10):895-901.

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Osteoporosis, low bone density: the improvement with fludrocortisone treatment (1 reference)

1. Camozzi V, Betterle C, Frigo AC, Zaccariotto V, Zaninotto M, De Caneva E, Lucato P, Gomiero W, Garelli S, Sabbadin C, Salvà M, Costa MD, Boscaro M, Luisetto G. Vertebral fractures assessed with dual-energy X-ray absorptiometry in patients with Addison’s disease on glucocorticoid and mineralocorticoid replacement therapy. Endocrine. 2018 Feb;59(2):319-329.

Low quality of life and fatigue: the association with low aldosterone levels (2 references)

1. Miwa K. Down-regulation of renin-aldosterone and antidiuretic hormone systems in patients with myalgic encephalomyelitis/chronic fatigue syndrome. J Cardiol. 2017 Apr;69(4):684-688.
2. Miwa K, Fujita M. Renin-aldosterone paradox in patients with myalgic encephalomyelitis and orthostatic intolerance. Int J Cardiol. 2014 Mar 15;172(2):514-5.

Low quality of life: the improvement with fludrocortisone treatment (2 references)

1. Bacchetta J, Basmaison O, Leclerc AL, Bertholet-Thomas A, Cochat P, Ranchin B. Fludrocortisone as a new tool for managing tubulopathy after pediatric renal transplantation: a series of cases. Pediatr Nephrol. 2014 Oct;29(10):2061-4.
2. Bou-Holaigah I, Rowe PC, Kan J, Calkins H. The relationship between neurally mediated hypotension and the chronic fatigue syndrome. JAMA 1995 Sep 27;274(12):961-7

Depression: the association with low aldosterone levels (2 references)

1. Hallberg L, Westrin A, Isaksson A, Janelidze S, Träskman-Bendz L, Brundin L. Decreased aldosterone in the plasma of suicide attempters with major depressive disorder. Psychiatry Res. 2011 May 15;187(1-2):135-9.
2. Holsboer F, Dörr HG, Sippell WG. Blunted aldosterone response to dexamethasone in female patients with endogenous depression. Psychoneuroendocrinology. 1982;7(2-3):155-62.

Memory loss, cognitive impairment: the improvement with fludrocortisone treatment (6 references)

1. Piber D, Schultebraucks K, Mueller SC, Deuter CE, Wingenfeld K, Otte C. Mineralocorticoid receptor stimulation effects on spatial memory in healthy young adults: A study using the virtual Morris Water Maze task. Neurobiol Learn Mem. 2016 Dec;136:139-146.
2. Otte C, Wingenfeld K, Kuehl LK, Richter S, Regen F, Piber D, Hinkelmann K. Cognitive function in older adults with major depression: Effects of mineralocorticoid receptor stimulation. J Psychiatr Res. 2015 Oct;69:120-5.
3. Schultebraucks K1, Wingenfeld K, Otte C, Quinkler M. The role of fludrocortisone in cognition and mood in patients with primary adrenal insufficiency (Addison’s Disease). Neuroendocrinology. 2016;103(3-4):315-20.
4. Wingenfeld K, Kuehl LK, Janke K, Hinkelmann K, Eckert FC, Roepke S, Otte C. Effects of mineralocorticoid receptor stimulation via fludrocortisone on memory in women with borderline personality disorder. Neurobiol Learn Mem. 2015 Apr;120:94-100.
5. Hinkelmann K, Wingenfeld K, Kuehl LK, Fleischer J, Heuser I, Wiedemann K, Otte C. Stimulation of the mineralocorticoid receptor improves memory in young and elderly healthy individuals. Neurobiol Aging. 2015 Feb;36(2):919-24

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Sleep apnea: no association with aldosterone levels (1 reference)

1. Svatikova A, Olson LJ, Wolk R, Phillips BG, Adachi T, Schwartz GL, Somers VK. Obstructive sleep apnea and aldosterone. Sleep. 2009 Dec;32(12):1589-92.

Sleep apnea: the association with high aldosterone levels in patients with resistant hypertension (3 references)

1. de Souza F, Muxfeldt ES, Margallo V, Cortez AF, Cavalcanti AH, Salles GF. Effects of continuous positive airway pressure treatment on aldosterone excretion in patients with obstructive sleep apnoea and resistant hypertension: a randomized controlled trial. J Hypertens. 2017 Apr;35(4):837-844.
2. Gonzaga CC, Gaddam KK, Ahmed MI, Pimenta E, Thomas SJ, Harding SM, Oparil S, Cofield SS, Calhoun DA. Severity of obstructive sleep apnea is related to aldosterone status in subjects with resistant hypertension. J Clin Sleep Med. 2010 Aug 15;6(4):363-8.
3. Pratt-Ubunama MN, Nishizaka MK, Boedefeld RL, Cofield SS, Harding SM, Calhoun DA. Plasma aldosterone is related to severity of obstructive sleep apnea in subjects with resistant hypertension. Chest. 2007 Feb;131(2):453-9.