Gender Variances for Depression, Anxiety, Sleep in Primary Aldosteronism

Researchers found study data that in patients with primary aldosteronism, men have higher blood pressure and body mass index levels, but women with primary aldosteronism have significant associations between blood pressure and anxiety and depressive symptoms.

Gender differences exist between men and women with primary aldosteronism that is linked to depression, anxiety, and quality of sleep, according to a study published in the Journal of Psychiatric Research.

Researchers used sleep electroencephalograms to assess the role of aldosterone excess on psychoneuroendocrine regulations in patients with primary aldosteronism, patients with depression, and healthy controls. All study participants completed clinical evaluations, laboratory assessments, psychiatric scales, and sleep electroencephalograms.

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The study included 19 patients with primary aldosteronism (mean age 47.11 years and 52.63% women), 19 age- and sex-matched patients with depression, and 19 age- and sex-matched healthy controls. The clinical and laboratory assessments found men with primary aldosteronism had higher mean blood pressure (153.89/100.00 mmHg vs 142.67/91.22 mmHg), higher mean body mass index (28.83 kg/m² vs 25.73 kg/m²), and higher mean waist-to-hip ratio (0.99 vs 0.87; P =.001) when compared with women. Further, patients with primary aldosteronism had lower cortisol levels (12.87 μg/dl vs 16.32 μg/dl) when compared with patients with depression.

The psychiatric scales indicated women with primary aldosteronism had higher mean values for all psychiatric scales especially the Hamilton Rating Scale for Depression (P =.025) when compared with men. The sleep questionnaires indicated patients with primary aldosteronism experienced worse sleep quality and daily fatigue when compared with the general population. The sleep electroencephalograms indicated patients with primary aldosteronism had significantly shorter mean N2 latency (4.58 vs 26.03; P =.037) and mean N3 latency (26.32 vs 59.5; P =.023) when compared with patients with depression, and men with primary aldosteronism experienced longer total sleep times (402.22 vs 364.56; P =.018) and better sleep efficiency (83.99 vs 75.58; P =.015) when compared with men with depression.

After the correlation analysis, men with primary aldosteronism had an association between light sleep stages and serum aldosterone levels (r=-0.872), the aldosterone/renin ratio (r=-0.818), and plasma renin levels (r=0.761). Women with primary aldosteronism had an association between the deeper sleep stages and serum cortisol (r=0.747) and plasma renin (r=0.021). Women also had an association between blood pressure and generalized anxiety disorder questionnaire (mean systolic r=0.754, mean systolic at night r=0.752), the Beck Inventory of Depression (mean diastolic at night r=0.824), the Epworth Sleepiness Scale (mean diastolic r=0.718), and the mental components of the SF-12 questionnaire correlated (mean systolic at night r=-0.969, mean diastolic at night r=-0.917).

Limitations of this study include small sample size and not measuring aldosterone levels in patients with depression.

Researchers concluded that this “data suggest gender related effects of aldosterone excess in [men and women]” and “support the relevance of gender specific studies and treatment strategies in depression and anxiety.”


Engler L, Heinrich DA, Adolf C, et al. Sleep-EEG in patients with primary aldosteronism in comparison to healthy controls and patients with depression [published online February 23, 2019]. J Psychiatr Res. doi:10.1016/j.jpsychires.2019.02.020