Does fludrocortisone treatment cause hypomagnesemia in children with primary adrenal insufficiency?

Turk J Med Sci. 2021 Feb 26;51(1):231-237. doi: 10.3906/sag-2008-167.

Abstract

Background/aim: Aldosterone is a mineralocorticoid that secreted from adrenal glands and a known factor to increase magnesium excretion by direct and indirect effects on renal tubular cells. Although the frequency of hypomagnesemia was found to be approximately 5% in adult studies, there is no study in the literature investigating the frequency of hypomagnesemia in children by using fludrocortisone, which has a mineralocorticoid activity.

Materials and methods: A multi-center retrospective study was conducted, including children who were under fludrocortisone treatment for primary adrenal insufficiency and applied to participant pediatric endocrinology outpatient clinics.

Results: Forty-three patients (58.1% male, 41.9% prepubertal) included in the study, whose median age was 9.18 (0.61-19) years, and the most common diagnosis among the patients was a salt-wasting form of congenital adrenal hyperplasia (67.4%). Mean serum magnesium level was 2.05 (±0.13) mg/dL, and hypomagnesemia was not observed in any of the patients treated with fludrocortisone. None of the patients had increased urinary excretion of magnesium.

Conclusion: Unlike the studies performed in adults, we could not find any evidence of magnesium wasting effect of fludrocortisone treatment with normal or even high doses in children and adolescents.

Keywords: Mineralocorticoids; magnesium; magnesuria; pediatrics; primary adrenal insufficiency.

Publication types

  • Multicenter Study

MeSH terms

  • Adrenal Hyperplasia, Congenital* / blood
  • Adrenal Hyperplasia, Congenital* / diagnosis
  • Adrenal Hyperplasia, Congenital* / drug therapy
  • Child
  • Drug Monitoring / methods
  • Female
  • Fludrocortisone* / administration & dosage
  • Fludrocortisone* / adverse effects
  • Humans
  • Ion Transport / drug effects
  • Magnesium Deficiency* / diagnosis
  • Magnesium Deficiency* / etiology
  • Magnesium Deficiency* / prevention & control
  • Magnesium* / blood
  • Magnesium* / urine
  • Male
  • Mineralocorticoids / administration & dosage
  • Mineralocorticoids / adverse effects
  • Renal Elimination / drug effects
  • Retrospective Studies
  • Risk Assessment
  • Treatment Outcome

Substances

  • Mineralocorticoids
  • Magnesium
  • Fludrocortisone