P-004 CAN ALDOSTERONE AND RENIN LEVELS BE RELIABLE IN DEPRESSIVE OR OBESE PATIENTS?

Abstract Introduction Chronic depression symptoms were stated to increase renin angiotensin aldosterone system (RAAS) activity and could be causal to hypertension. Volume overload develops which consequently decreases renin activity. Selective serotonin reuptake inhibitor antidepressants can significantly reduce ARR, while increasing both aldosterone and PRA. Moreover, antipsychotics have a stimulatory action on aldosterone release. Secondly, obese individuals frequently develop hypertension, which is for an important part attributable to RAAS overactivity. Clinical Case A 38-year-old female arrived at our clinic because of consistent hypertension in duration of one year which reaches 200/110 mmhg sometimes. She had not pheochromocytoma symptoms. She had diabetes mellitus for one year and depression for seven years. Her blood pressure was 140/85 mmhg; had a 82/min pulse rate. Her drugs were: 250 mg primidone; 240 mg verapamil, 1000 mg metformin, 10 mg dapagliflozin; 500 mg valproic acid, 75 mg Venlafaxine, 50 mg quetiapine. Her renal ultrasonography and renal doppler ultrasonography revealed normal results. Her glycohemoglobin(HbA1c) was 6% whereas creatinine(cre):0.9; alanine aminotransferase (ALT):34, potassium(K):5 mEq/l, sodium:138 mEq/l, metanephrine and normetanephrine levels in 24 hour urine were normal; dexamethasone suppression test was normal whereas aldosterone 10.8 ng/dl, plasma renin activity(PRA):0.31 ng/ml/h. Saline infusion test was performed and aldosterone level was found to be 10.5 ng/dl. Contrast enhanced adrenal magnetic resonance imaging was applied and there was no lesion found. She was recommended to go to her psychiatrist to obtain to check out her psychiatric drug list whether to change or stop any of her drugs to not any further indulge in aldosterone activity and if she were to be referred to psychologist to have an interview programme to decrease the etiological factors in her depression. She was prescribed a diet programme and orlistat to reach intended weight. Conclusion Obesity and depression are two conditions which RAAS can be affected; so ARR would be falsely interpreted. The psychiatric drugs used in depression are also causatic in this perplexity. In that group of patients clinicians might be more reluctant to proceed in the diagnostic process if the patient is not hypokalemic or the hypertension is not severe under adequate antihypertensive medication. Instead of deeper investigation for suspected PRA, the number of psychiatric drugs would be decreased, the reasons of depression might be reevaluated, and the weight loss might be targeted to alleviate RAAS activity. References 1-Arnoldeen C De Vos et al, Physiol Behav. 2018 Oct 1:194:474-480. 2-Zuzana Romanova et al, Int J Mol Sci. 2022 Jan 14;23(2):908. 3-Ashraf H Ahmed et al, J Clin Endocrinol Metab. 2011 Apr;96(4):1039-45