MINERALOCORTICOID EXCESS IN TWO BROTHERS WITH DWARFISM, HYPOKALAEMIC ALKALOSIS AND NORMAL BLOOD PRESSURE

1967 ◽  
Vol 55 (4) ◽  
pp. 661-672 ◽  
Author(s):  
H. K. A. Visser ◽  
H. J. Degenhart ◽  
E. Desmit ◽  
W. S. Cost
Keyword(s):  
Blood Pressure ◽  
Sodium Intake ◽  
Plasma Renin ◽  
High Plasma ◽  
Normal Blood ◽  
Normal Blood Pressure ◽  
Primary Defect ◽  
High Sodium ◽  
Regular Control ◽  
Renal Tubular

ABSTRACT Using isotope dilution methods the secretion rates of cortisol, aldosterone, deoxycorticosterone, corticosterone and 18-hydroxycorticosterone were determined in two brothers (76/12 and 108/12 years old) with dwarfism, chronic hypokalaemia alkalosis, tendency to hyponatraemia and normal blood pressure. Both patients showed a decreased response of the blood pressure to infused angiotensin. The urinary excretion of cortisol, cortisone, corticosterone, 11-dehydrocorticosterone and their tetrahydrometabolites as well as of aldosterone was determined. In general, results were in agreement with those of the secretion rate studies. The results suggest a relatively small mineralocorticoid excess (mainly corticosterone) to high plasma-renin concentrations. The differences in both the plasma-renin concentrations and the steroid secretory rates during low and high sodium intake indicate that the renin-angiotensin-mineralocorticoid system is still under regular control, although the normal regulatory process is severely disturbed. The primary defect in these patients is probably not a relative insensitivity of the arterial walls to the pressor effect of angiotensin as suggested by Bartter et al. (1962), but rather a renal tubular defect in the re-absorption of sodium.

Abstract P349: Dietary Sodium Intake according to the Hypertension Management Status: The Fourth Korea National Health and Nutrition Examination Survey.

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Won Joon Lee ◽  
Hyeon Chang Kim ◽  
Sun Min Oh ◽  
Dong Phil Choi ◽  
Hye Min Cho ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Body Mass Index ◽  
Energy Intake ◽  
Sodium Intake ◽  
Normal Blood ◽  
Hypertension Management ◽  
Nutrition Examination Survey ◽  
Normal Blood Pressure ◽  
Health And Nutrition ◽  
Eating Out

Introduction : High sodium intake is an established risk factor for hypertension and cardiovascular diseases. The average sodium intake in Koreans was estimated at 4,645mg/day, which was more than two times compared to the recommended amount, 2000mg/day. We assessed whether people who diagnosed with hypertension or treated for hypertension consume less sodium than those without hypertension. Methods : The present study analyzed data from a total of 6,577 Koreans (3,816 women and 2,761 men) aged 40 years and older, participated in the Korea National Health and Nutrition Examination Survey (KNHANES IV, 2007-2008). Participants were classified into five groups as follows: normal blood pressure, pre-hypertension, hypertension without treatment, hypertension with treatment, and hypertension with complications. The association between sodium intake and hypertension management status was estimated using exponential regression coefficient, adjusted for potential confounders including age, energy intake, body mass index, income, education, marriage, occupation, the frequency of eating out and effort to lower sodium intake. Results : In women, the median sodium intake tended to decrease according to the following groups; 3,708mg in normal blood pressure, 3,515mg in pre-hypertension, 3,191mg in hypertension without treatment, 3,113mg in hypertension with treatment, and 2,862mg in hypertension with complications (P for trend < 0.001). In men, a similar trend was shown, but sodium consumption was the highest in the prehypertension group; 5,099mg in normal blood pressure, 5,353mg in pre-hypertension, 5,118mg in hypertension without treatment, 4,708mg in hypertension with treatment, and 3,798mg in hypertension with complications (P for trend < 0.001). After controlling for potential confounders (energy intake, body mass index, occupation, the frequency of eating out), the trend was not significant both in women (P for trend= 0.887) and men (P for trend=0. 204). Only in men with prehypertension, sodium intake was 1.08 times higher than that in normal blood pressure group (P = 0.025). Conclusions : The present study showed that Korean women and men consumed sodium more than the recommended amount regardless of the presence of, the treatment for, or knowing the complications of hypertension. Moreover, men with prehypertension consumed the highest amount of sodium.

A case of normotensive primary aldosteronism with hypopituitarism, epilepsy, and medullary sponge kidney

1989 ◽  
Vol 121 (6) ◽  
pp. 797-801 ◽  
Author(s):  
Takeo Kuroda ◽  
Ken Okamura ◽  
Mototaka Yoshinari ◽  
Hiroshi Ikenoue ◽  
Kaori Sato ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Plasma Renin Activity ◽  
Primary Aldosteronism ◽  
Metabolic Alkalosis ◽  
Plasma Renin ◽  
Normal Blood ◽  
Normal Blood Pressure ◽  
Medullary Sponge Kidney ◽  
High Potassium ◽  
Potassium Clearance

Abstract. A 55-year-old man with normotensive primary aldosteronism, hypopituitarism, epilepsy, and medullary sponge kidney is reported. Seventeen years before admission, he had been noted to have hypokalemia associated with high potassium clearance, suppressed plasma renin activity, metabolic alkalosis, and normal blood pressure as well as low urinary excretion of 17-hydroxycorticosteroids. He kept normotensive in spite of hyperaldosteronism until nine months after the initiation of replacement therapy with glucocorticoid and thyroxine for hypopituitarism, when he became hypertensive. Hypopituitarism seemed to play a role in keeping a normal blood pressure despite long-standing hyperaldosteronism.

Effects of Nifedipine during Low, Normal and High Intakes of Sodium in Patients with Essential Hypertension

1982 ◽  
Vol 63 (s8) ◽  
pp. 447s-450s ◽  
Author(s):  
Gloria Valdés ◽  
M. Eugenia Soto ◽  
Hector R. Croxatto ◽  
Teresa Bellolio ◽  
Ramón Corbalán ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Essential Hypertension ◽  
Sodium Intake ◽  
Plasma Renin ◽  
Hypotensive Effect ◽  
Sodium Balance ◽  
Hypotensive Action ◽  
High Sodium ◽  
High Sodium Intake ◽  
Low Sodium Diet

1. Nifedipine (20 mg) was given by mouth to seven patients with moderate essential hypertension receiving a low, normal or high sodium intake. The drug produced an important hypotensive effect. Normal sodium intake enhanced the hypotensive action of the drug compared with that during the low and high sodium regimens. Blood pressure remained significantly lower 3 h after drug ingestion. 2. Increases in heart rate and plasma renin activity under all conditions reflected enhanced adrenergic activity. 3. A short-term natriuresis followed nifedipine ingestion in spite of increased aldosterone excretion during the low sodium diet and a decrease in urinary kallikrein during the low and high sodium diets. 4. Nifedipine increased urinary volume only during the high sodium intake. 5. Apart from vasodilatation, nifedipine induces important changes in neurogenic, renal and adrenal mechanisms that regulate blood pressure homoeostasis. Different conditions of sodium balance modulate most of these effects.

scholarly journals Rare Variant of Bartter Syndrome with Sensorineural Deafness

2016 ◽  
Vol 35 (3) ◽  
pp. 293-294
Author(s):  
Rajesh Kumar ◽  
Pankaj Kumar ◽  
Manoj Kumar
Keyword(s):  
Blood Pressure ◽  
Sodium Chloride ◽  
Rare Variant ◽  
Metabolic Alkalosis ◽  
Sensorineural Deafness ◽  
Bartter Syndrome ◽  
Normal Blood ◽  
Normal Blood Pressure ◽  
Renal Tubular Disorder ◽  
Renal Tubular

Bartter syndrome is an inherited renal tubular disorder characterized by hypokalemia, hypochloremic metabolic alkalosis, hyperreninemia, hyper-prostaglandinism, normal blood pressure, with increased urinary loss of sodium, chloride, potassium, calcium and prostaglandins. There are five known type of Bartter syndrome, out of which type 4 and 5 are very rare. We are presenting here a case of Bartter syndrome with sensorineural hearing loss.J Nepal Paediatr Soc 2015;35(3):293-294.

scholarly journals Normal Blood Pressure and Plasma Renin Activity in Mice Lacking the Renin-binding Protein, a Cellular Renin Inhibitor

2000 ◽  
Vol 275 (20) ◽  
pp. 15357-15362 ◽  
Author(s):  
Christian Schmitz ◽  
Michael Gotthardt ◽  
Stephan Hinderlich ◽  
Jörg-Robert Leheste ◽  
Volkmar Gross ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Plasma Renin Activity ◽  
Binding Protein ◽  
Protein A ◽  
Plasma Renin ◽  
Renin Activity ◽  
Renin Inhibitor ◽  
Normal Blood ◽  
Normal Blood Pressure

Classic and Nonclassic Apparent Mineralocorticoid Excess Syndrome

2019 ◽  
Vol 105 (4) ◽  
pp. e924-e936 ◽  
Author(s):  
Cristian A Carvajal ◽  
Alejandra Tapia-Castillo ◽  
Andrea Vecchiola ◽  
Rene Baudrand ◽  
Carlos E Fardella
Keyword(s):  
Blood Pressure ◽  
Sodium Intake ◽  
Evidence Synthesis ◽  
Plasma Renin ◽  
Organ Damage ◽  
Second Hit ◽  
High Sodium ◽  
Endocrine Hypertension ◽  
Urinary Potassium ◽  
Apparent Mineralocorticoid Excess

Abstract Context Arterial hypertension (AHT) is one of the most frequent pathologies in the general population. Subtypes of essential hypertension characterized by low renin levels allowed the identification of 2 different clinical entities: aldosterone-mediated mineralocorticoid receptor (MR) activation and cortisol-mediated MR activation. Evidence Acquisition This review is based upon a search of Pubmed and Google Scholar databases, up to August 2019, for all publications relating to endocrine hypertension, apparent mineralocorticoid excess (AME) and cortisol (F) to cortisone (E) metabolism. Evidence Synthesis The spectrum of cortisol-mediated MR activation includes the classic AME syndrome to milder (nonclassic) forms of AME, the latter with a much higher prevalence (7.1%) than classic AME but different phenotype and genotype. Nonclassic AME (NC-AME) is mainly related to partial 11βHSD2 deficiency associated with genetic variations and epigenetic modifications (first hit) and potential additive actions of endogenous or exogenous inhibitors (ie, glycyrrhetinic acid-like factors [GALFS]) and other factors (ie, age, high sodium intake) (second hit). Subjects with NC-AME are characterized by a high F/E ratio, low E levels, normal to elevated blood pressure, low plasma renin and increased urinary potassium excretion. NC-AME condition should benefit from low-sodium and potassium diet recommendations and monotherapy with MR antagonists. Conclusion NC-AME has a higher prevalence and a milder phenotypical spectrum than AME. NC-AME etiology is associated to a first hit (gene and epigene level) and an additive second hit. NC-AME subjects are candidates to be treated with MR antagonists aimed to improve blood pressure, end-organ damage, and modulate the renin levels.

Neurogenic regulation of rate of achieving sodium balance after increasing sodium intake

1991 ◽  
Vol 261 (2) ◽  
pp. F300-F307 ◽  
Author(s):  
S. G. Greenberg ◽  
S. Tershner ◽  
J. L. Osborn
Keyword(s):  
Sodium Intake ◽  
Plasma Renin ◽  
Sympathetic Nerves ◽  
Urinary Sodium Excretion ◽  
Significant Inhibition ◽  
Sodium Balance ◽  
Renal Nerves ◽  
High Sodium ◽  
Low Sodium ◽  
Renal Tubular

Evidence that the renal sympathetic nerves have direct effects on renal tubular function suggests that neurogenic mechanisms may play an important role in the daily regulation of sodium balance. We evaluated the influence of the renal nerves on the rate of elevating urinary sodium excretion (UNaV) after a step increase in fixed sodium intake. Conscious rats with innervated (INN) or denervated (DNX) kidneys were placed on low-sodium intake (LNa = 0.3 meq/day) or a normal sodium intake (NNa = 1.0 meq/day) by intravenous infusion. Hourly changes in UNaV were determined 24 h before and 72 h after increasing sodium intake to either NNa or high-sodium intake (HNa = 5.0 meq/day). Switching from LNa to NNa, INN rats increased UNaV within 24 h; however, DNX rats did not begin to increase UNaV until hour 60. Cumulative sodium balance over 72 h was more positive in DNX rats (INN = 1.29 +/- 0.29 meq; DNX = 2.06 +/- 0.21 meq, P less than 0.05). During the LNa-to-HNa switch, both INN and DNX rats increased UNaV equally for 12 h; however, at this time INN rats continued to increase UNaV, whereas DNX rats did not. DNX rats had a net accumulation of 2.54 meq more sodium than INN rats over 72 h. Significant inhibition of plasma renin activity within the first 24 h occurred only in rats receiving the LNa-to-HNa switch in sodium intake, and this response was not different between rats with innervated and denervated kidneys. These data suggest that the renal nerves provide a rapid sodium excretory response to step increases in sodium intake.(ABSTRACT TRUNCATED AT 250 WORDS)

Influence of melatonin on blood pressure indicators with different severity of desynchronosis

2020 ◽  
pp. 30-40
Author(s):  
M. G. Melnik
Keyword(s):  
Blood Pressure ◽  
Circadian Rhythms ◽  
Antihypertensive Drugs ◽  
Blood Pressure Monitoring ◽  
Home Monitoring ◽  
Normal Blood ◽  
Normal Blood Pressure ◽  
Pronounced Decrease ◽  
The Third ◽  
Pressure Indicators

Purpose. To study the dynamics of blood pressure (BP) indicators under the influence of exogenously administered melatonin (Melatonin-SZ, Severnaya Zvezda, Russia) with various manifestations of desynchronosis of circadian BP rhythms (arterial hypertension – AH, high normal blood pressure) to determine the scheme of their effective compensation. Material and methods. The study included 101 patients with desynchronosis of circadian rhythms of blood pressure – 52 patients with hypertension, constituting the first and second groups, and 49 individuals with high normal blood pressure, representing the third and fourth groups. Patients of the second and fourth groups received conservative therapy, patients of the first and third groups combined it with melatonin. All patients underwent measurements of office blood pressure, home monitoring of blood pressure (ABPM), electrocardiography, 24-hour blood pressure monitoring (ABPM). Results and discussion. In patients of the first and third groups, compared with the traditional treatment groups, by the end of the observation period, a significantly (p < 0.05) decrease in office systolic blood pressure (SBP) / diastolic blood pressure (DBP) was established: in the first group compared with the second – 1.11 / 1.13 times, in the third group compared to the fourth – 1.43 / 1.58 times; significantly more (p < 0.05) pronounced decrease in SBP / DBP during DMAD – by 1.08 / 1.17 and 1.58 / 1.62 times, respectively, Significantly (p < 0.05) more pronounced decrease in average daily, average daily and average nighttime SBP / DBP during ABPM – by 1.13 / 1.20, 1.11 / 1.20, 1.23 / 1.25 and 1.47 / 1.31, 1.42 / 1.19, 1.54 / 1.41 times, respectively; reliably (p < 0.05) more frequent registration of the dipper rhythm type SBP / DBP – 1.6 / 1.4 and 1.6 / 1.4 times, respectively. In addition, the dynamics of patients in the first and third groups showed a significant (p < 0.05) decrease in the mean daily and mean nighttime SBP / DBP variability (SBP in the first group by 27.3 and 41.3 %, respectively; DBP in the first group by 20.1 and 26.3 %, respectively; SBP in the third group by 13.5 and 25.2 %, respectively; DBP in the third group by 12.2 and 28.2 %, respectively). Conclusions. With various manifestations of desynchronosis of circadian rhythms of blood pressure (AH, high normal blood pressure), the prescription of melatonin (Melatonin-SZ, Severnaya Zvezda, Russia) at a dose of 3 mg per day 30–40 minutes before bedtime for a month against the background of non-drug therapy and antihypertensive drugs led to a significantly more effective decrease in blood pressure at its office measurement, DMAD, ABPM with an improvement in the circadian rhythm of blood pressure and normalization of blood pressure variability.

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