Thirty years of the heart as an endocrine organ: physiological role and clinical utility of cardiac natriuretic hormones

Am J Physiol Heart Circ Physiol. 2011 Jul;301(1):H12-20. doi: 10.1152/ajpheart.00226.2011. Epub 2011 May 6.


Thirty years ago, De Bold et al. (20) reported that atrial extracts contain some biologically active peptides, which promote a rapid and massive diuresis and natriuresis when injected in rats. It is now clear that the heart also exerts an endocrine function and in this way plays a key role in the regulation of cardiovascular and renal systems. The aim of this review is to discuss some recent insights and still-debated findings regarding the cardiac natriuretic hormones (CNHs) produced and secreted by cardiomyocytes (i.e., atrial natriuretic peptide and B-type natriuretic peptide). The functional status of the CNH system depends not only on the production/secretion of CNHs by cardiomyocytes but also on both the peripheral activation of circulating inactive precursor of natriuretic hormones and the transduction of the hormone signal by specific receptors. In this review, we will discuss the data supporting the hypothesis that the production and secretion of CNHs is the result of a complex integration among mechanical, chemical, hemodynamic, humoral, ischemic, and inflammatory inputs. The cross talk among endocrine function, adipose tissue, and sex steroid hormones will be discussed more in detail, considering the clinically relevant relationships linking together cardiovascular risk, sex, and body fat development and distribution. Finally, we will review the pathophysiological role and the clinical relevance of both peripheral maturation of the precursor of B-type natriuretic peptides and hormone signal transduction.

Publication types

  • Review

MeSH terms

  • Adipose Tissue / physiology
  • Animals
  • Atrial Natriuretic Factor / physiology
  • Atrial Natriuretic Factor / therapeutic use
  • Endocrine System / physiology*
  • Gonadal Steroid Hormones / physiology
  • Heart / physiology*
  • Humans
  • Natriuretic Agents / physiology*
  • Natriuretic Agents / therapeutic use*
  • Natriuretic Peptide, Brain / metabolism
  • Natriuretic Peptide, Brain / physiology
  • Natriuretic Peptide, Brain / therapeutic use


  • Gonadal Steroid Hormones
  • Natriuretic Agents
  • Natriuretic Peptide, Brain
  • Atrial Natriuretic Factor