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. 1966 Nov 26;95(22):1109–1119.

Hypertension, Increased Aldosterone Secretion and Low Plasma Renin Activity Relieved by Dexamethasone

D J A Sutherland, J L Ruse, J C Laidlaw
PMCID: PMC1935810  PMID: 4288576

Abstract

A father and son are described with a condition characterized by benign hypertension, potassium deficiency, increased aldosterone secretion rate (ASR), raised plasma volume and suppressed plasma renin activity (PRA). There were intermittent elevations of urine 17-ketosteroids and 17-hydroxycorticoids (17-OHCS) but no increase in urine THS, normal circadian rhythm of plasma 17-OHCS, and normal urine 17-OHCS response to dexamethasone and intravenous ACTH. Plasma ACTH and corticosterone secretion were not elevated. Pregnanetriol excretion was normal but urine pregnanediol was increased. At operation on the father no adrenal tumour was found; the excised left adrenal weighed 7 g. and showed nodular cortical hyperplasia; juxtaglomerular cells showed only occasional granules. Following operation hypertension persisted and ASR was half the preoperative value. All abnormalities in father and son were relieved by dexamethasone (DM) 2 mg. daily. The condition recurred following cessation of DM but was relieved by a second course of treatment. No such response to DM was seen in a normal subject or in a patient with Conn's syndrome. For a number of reasons it is suggested that patients with hypertension, increased ASR and low PRA be given a trial of dexamethasone treatment before undergoing adrenal surgery.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. AUST J. B., CHOU S. N., MARVIN J. F., BRACKNEY E. L., MOORE G. E. A rapid method for clinical total blood volume determination using radioactive iodinated human serum albumin (RIHSA). Proc Soc Exp Biol Med. 1951 Jul;77(3):514–518. doi: 10.3181/00379727-77-18832. [DOI] [PubMed] [Google Scholar]
  2. BARTTER F. C., DUNCAN L. E., Jr, LIDDLE G. W. Dual mechanism regulating adrenocortical function in man. Am J Med. 1956 Sep;21(3):380–386. doi: 10.1016/0002-9343(56)90038-9. [DOI] [PubMed] [Google Scholar]
  3. BONGIOVANNI A. M., EBERLEIN W. R. Plasma and urinary corticosteroids in the hypertensive form of congenital adrenal hyperplasia. J Biol Chem. 1956 Nov;223(1):85–94. [PubMed] [Google Scholar]
  4. CONN J. W., CONN E. S. Primary aldosteronism versus hypertensive disease with secondary aldosteronism. Recent Prog Horm Res. 1961;17:389–414. [PubMed] [Google Scholar]
  5. CONN J. W., KNOPF R. F., NESBIT R. M. CLINICAL CHARACTERISTICS OF PRIMARY ALDOSTERONISM FROM AN ANALYSIS OF 145 CASES. Am J Surg. 1964 Jan;107:159–172. doi: 10.1016/0002-9610(64)90252-1. [DOI] [PubMed] [Google Scholar]
  6. CONN J. W., ROVNER D. R., COHEN E. L. NORMAL AND ALTERED FUNCTION OF THE RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM IN MAN: APPLICATIONS IN CLINICAL AND RESEARCH MEDICINE. Ann Intern Med. 1965 Aug;63:266–284. doi: 10.7326/0003-4819-63-2-266. [DOI] [PubMed] [Google Scholar]
  7. Callow N. H., Callow R. K., Emmens C. W. Colorimetric determination of substances containing the grouping -CH(2).CO- in urine extracts as an indication of androgen content. Biochem J. 1938 Aug;32(8):1312–1331. doi: 10.1042/bj0321312. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. DOOLAN P. D., ALPEN E. L., THEIL G. B. A clinical appraisal of the plasma concentration and endogenous clearance of creatinine. Am J Med. 1962 Jan;32:65–79. doi: 10.1016/0002-9343(62)90183-3. [DOI] [PubMed] [Google Scholar]
  9. FISHER B. F., FISHER E. R. Observations on the eosinophil count in man; a proposed test of adrenal cortical function. Am J Med Sci. 1951 Feb;221(2):121–132. doi: 10.1097/00000441-195102000-00001. [DOI] [PubMed] [Google Scholar]
  10. HAUGEN H. N., BLEGEN E. M. The true endogenous creatinine clearance. Scand J Clin Lab Invest. 1953;5(1):67–71. doi: 10.3109/00365515309093514. [DOI] [PubMed] [Google Scholar]
  11. HENKE W. J., DOE R. P., JACOBSON M. E. A test of pituitary reserve utilizing intravenous SU-4885, with a new method for extraction of 11-desoxvcorticosteroids. J Clin Endocrinol Metab. 1960 Nov;20:1527–1531. doi: 10.1210/jcem-20-11-1527. [DOI] [PubMed] [Google Scholar]
  12. ITTRICH G. [A method for the clinical routine determination of urinary estrogens]. Zentralbl Gynakol. 1960 Mar 12;82:429–438. [PubMed] [Google Scholar]
  13. KAPLAN N. M., SILAH J. G. THE EFFECT OF ANGIOTENSIN II ON THE BLOOD PRESSURE IN HUMANS WITH HYPERTENSIVE DISEASE. J Clin Invest. 1964 Apr;43:659–669. doi: 10.1172/JCI104951. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. KOWARSKI A., FINKELSTEIN J. W., SPAULDING J. S., HOLMAN G. H., MIGEON C. J. ALDOSTERONE SECRETION RATE IN CONGENITAL ADRENAL HYPERPLASIA. A DISCUSSION OF THE THEORIES ON THE PATHOGENESIS OF THE SALT-LOSING FORM OF THE SYNDROME. J Clin Invest. 1965 Sep;44:1505–1513. doi: 10.1172/JCI105257. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. LAIDLAW J. C., REDDY W. J., JENKINS D., HAYDAR N. A., RENOLD A. E., THORN G. W. Advances in the diagnosis of altered states of adrenocortical function. N Engl J Med. 1955 Nov 3;253(18):747–753. doi: 10.1056/NEJM195511032531801. [DOI] [PubMed] [Google Scholar]
  16. LAIDLAW J. C., REDDY W. J., JENKINS D., HAYDAR N. A., RENOLD A. E., THORN G. W. Advances in the diagnosis of altered states of adrenocortical function. N Engl J Med. 1955 Nov 3;253(18):747–753. doi: 10.1056/NEJM195511032531801. [DOI] [PubMed] [Google Scholar]
  17. LAIDLAW J. C., YENDT E. R., BIRD C. E., GORNALL A. G. HYPERTENSION DUE TO RENAL ARTERY OCCLUSION SIMULATING PRIMARY ALDOSTERONISM. Can Med Assoc J. 1964 Jan 25;90:321–325. [PMC free article] [PubMed] [Google Scholar]
  18. LARAGH J. H., ULICK S., JANUSZEWICZ V., DEMING Q. B., KELLY W. G., LIEBERMAN S. Aldosterone secretion and primary and malignant hypertension. J Clin Invest. 1960 Jul;39:1091–1106. doi: 10.1172/JCI104124. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. NEY R. L., SHIMIZU N., NICHOLSON W. E., ISLAND D. P., LIDDLE G. W. CORRELATION OF PLASMA ACTH CONCENTRATION WITH ADRENOCORTICAL RESPONSE IN NORMAL HUMAN SUBJECTS, SURGICAL PATIENTS, AND PATIENTS WITH CUSHING'S DISEASE. J Clin Invest. 1963 Nov;42:1669–1677. doi: 10.1172/JCI104853. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. REDDY W. J. Modification of the Reddy-Jenkins-Thorn method for the estimation of 17-hydroxycorticoids in urine. Metabolism. 1954 Nov;3(6):489–492. [PubMed] [Google Scholar]
  21. SLATON P. E., BIGLIERI E. G. HYPERTENSION AND HYPERALDOSTERONISM OF RENAL AND ADRENAL ORIGIN. Am J Med. 1965 Mar;38:324–336. doi: 10.1016/0002-9343(65)90142-7. [DOI] [PubMed] [Google Scholar]
  22. SZENAS P., PATTEE C. J. Studies on adrenocortical function in obesity. J Clin Endocrinol Metab. 1959 Mar;19(3):344–350. doi: 10.1210/jcem-19-3-344. [DOI] [PubMed] [Google Scholar]
  23. THERIEN B., MELLINGER R. C., CALDWELL J. R., HOWARD P. J. Primary aldosteronism due to adrenal hyperplasia; occurrence in a boy aged 10 years. AMA J Dis Child. 1959 Jul;98(1):90–99. doi: 10.1001/archpedi.1959.02070020092012. [DOI] [PubMed] [Google Scholar]
  24. ULICK S., VETTER K. K. SIMULTANEOUS MEASUREMENT OF SECRETORY RATES OF ALDOSTERONE AND 18-HYDROXYCORTICOSTERONE. J Clin Endocrinol Metab. 1965 Aug;25:1015–1026. doi: 10.1210/jcem-25-8-1015. [DOI] [PubMed] [Google Scholar]

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