Influence of spironolactone on serum corticosteroids in primary hyperaldosteronism.
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Fourteen patients with sickle cell anemia, ages 6 to 20 years, were studied while ingesting high- and low-sodium diets. Although none of the patients had excessive urinary loss of sodium, the majority had elevated plasma renin activities and aldosterone secretion rates. The PRA was higher in patients over 10 years of age; ASR in patients receiving the high-sodium diet increased with age. Patients with sickle cell anemia appeared to compensate for urinary sodium loss between crises. The mechanism of this loss could be a defect in the function of either the distal tubule or the loop of Henle.
A case of acute intermittent porphyria associated with inappropriate antidiuretic hormone secretion and secondary aldosteronism is presented. Hypokalemic alkalosis was a prominent feature of this case, and appeared to be at least partly caused by secondary aldosteronism.
Measurement of plasma aldosterone concentrations (PAC) at 8 a.m. and after 4 h in the upright posture can further assist in identifying the adrenal pathologic lesion in patients with primary aldosteronism. Increases in PAC are associated with hyperplasia, and decreases with adenoma. Normal increases in response to upright posture are observed in patients with essential hypertension with normal or reduced renin concentration.
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