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Temporal relationship between hyperaldosteronism, sodium retention and ascites formation in rats with experimental cirrhosis.

To investigate the role of aldosterone in sodium retention and ascites in cirrhosis, the urinary sodium excretion, sodium balance and urinary excretion of aldosterone-18-glucuronide (UAldV) were serially measured in 11 rats undergoing cirrhosis induction with carbon tetrachloride (CT) and phenobarbital (CT rats) and in 10 control rats which received phenobarbital. All CT rats developed ascites, seven within the ninth week after starting the program and four within the 10th week. One week before the onset of ascites, CT rats and control rats were different with respect to sodium excretion (1.41 +/- 0.15 vs. 1.82 +/- 0.1 mEq per day), sodium balance (0.57 +/- 0.12 vs. 0.20 +/- 0.09 mEq per day) and UAldV (67.8 +/- 9.5 vs. 25.7 +/- 1.7 ng per day). These differences were more pronounced within the week in which ascites was detected in CT rats. Before these 2 weeks, both groups did not differ with respect to these parameters. In the 132 urine samples obtained in CT rats, there was a correlation between sodium excretion and UAldV (r = -0.53; p less than 0.001). Twenty-one additional CT rats were divided into two groups. Eleven animals were given spironolactone (20 mg per day s.c. in olive oil) from the 6th week, and 10 only received olive oil. Thirteen weeks after starting the program, all rats not treated with spironolactone had sodium retention and ascites (in five rats, ascites appeared within the ninth week and in five within the tenth week); this occurred in only one animal treated with spironolactone.(ABSTRACT TRUNCATED AT 250 WORDS)

Aldosterone↗

[Endosonography -- an additional diagnostic possibility in the differentiation between the two common types of primary hyperaldosteronism].

BACKGROUND: Primary aldosteronism is an important and one of the few potentially curable forms of secondary hypertension. The distinction between aldosterone-producing adenoma (APA) and idiopathic adrenal hyperplasia (IHA) may be difficult, but establishing the correct diagnosis is essential because surgery is only effective in patients with adrenal adenoma. CASE REPORT: The case of a 65-year-old man with long-term hypertension due to an APA is reported. The routine laboratory tests displayed an elevated plasma aldosterone/renin quotient as well as an elevated 24-h urinary excretion of aldosterone and its metabolites. The serum aldosterone concentration did not decrease normally in the saline suppression test. The posture testing demonstrated an increase in aldosterone. These facts might lead to the conclusion of an IHA. Magnetic resonance imaging (MRI) of the adrenal glands revealed no abnormalities. Because of the unusual combination of laboratory findings and radiologic results an endosonographic examination of the adrenal glands was performed which yielded a unilateral adrenal adenoma. With establishing this diagnosis, curative surgery became possible. CONCLUSION: This case demonstrates that in the differential diagnosis of primary aldosteronism, endosonography is more important than previously discussed. It may be helpful in the differentiation of an unusual constellation of laboratory and radiologic findings.

Adenoma↗

Conn's syndrome (primary hyperaldosteronism) simulating polymyositis.

A 44-year-old woman presented with typical polymyositis findings associated with hypokalemia. Abdominal CT as well as plasma renin and aldosterone levels showed a right surrenal adenoma secreting aldosterone. Unilateral adrenalectomy was performed and resolved all the clinical and laboratory manifestations. Hypokalemia should be considered in the differential diagnosis of polymyositis, even in the face of inflammatory cell infiltration in the muscle biopsy.

Adrenal Cortex Neoplasms↗