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Aim. To determine the variability of serum aldosterone in patients with stable coronary artery disease in relation to arterial hypertension status, age, and gender. Materials and Methods. We recruited 176 consecutive patients with stable coronary artery disease and evaluated serum aldosterone by enzyme-linked immunosorbent assay, further comparing its levels with regards to age, gender, and presence of arterial hypertension. Results. Average serum aldosterone in patients with stable coronary artery disease was similar in Kemerovo Region and those reported in the literature. Age ≥ 60 years, female gender, and the presence of arterial hypertension were among the serum aldosterone determinants Conclusions. Females ≥ 60 years of age with a medical history of arterial hypertension have increased serum aldosterone.

Low-renin hypertension (LRH) is a frequent condition in patients with arterial hypertension, accounting for 30% of patients. Monogenic forms can cause LRH in a minority of cases. However, in the large majority of patients, LRH is caused by the combined effects of congenital and acquired factors, comprising dietary habits. Several genetic variants have been proposed as co-factors in the pathogenesis of LRH with normal-low serum aldosterone. Emerging evidences support the hypothesis that a large proportion of LRH with normal-high serum aldosterone is associated with subclinical primary aldosteronism (PA). The recent identification of aldosterone-producing cell clusters (APCCs) as the possible cause of subclinical PA, further supported the concept of a continuous spectrum of autonomous aldosterone secretion, from subclinical forms towards overt PA. In this review we describe the main aspects of LRH, focusing on molecular basis, clinical risk profile and patients' management.

Purpose: Primary aldosteronism (PA) is considered the most common form of secondary hypertension, however, its prevalence, particularly in a general population, is still a matter of debate. The aim...

This study aimed to examine the effect of pool walking on renal function in pregnant women. Fifteen pregnant women (mean gestational age, 37.8 weeks) walked in a pool (depth 1.3 m) for 1 h. A few days later, they walked on a street for 1 h. Within each activity, the starting and ending levels of plasma renin activity were measured. The total urine volume, creatinine clearance, and change in plasma renin activity levels between each activity were compared by Wilcoxon rank-sum test. The renin-angiotensin-aldosterone level was suppressed during pool walking: the mean starting and ending values of plasma renin activity and serum aldosterone were 6.8 vs. 5.5 ng/mL/h (p = 0.002) and 654 vs. 473 pg/mL (p = 0.01), respectively. The decreases in plasma renin activity and serum aldosterone levels were more evident in pool walking than in land walking (plasma renin activity, −1.27 vs. 0.81 ng/mL/h, p = 0.002; serum aldosterone, −180.9 vs. 3.1 ng/mL/h, p = 0.03), resulting in higher total urine volume (299 vs. 80 mL, p

An eight-year-old, female, neutered labradoodle was presented for investigation of a three-week history of lethargy and regurgitation. Two sets of conscious thoracic radiographs, performed approximately two weeks apart, revealed the presence of megaoesophagus. Serum cortisol concentration (pre-adrenocorticotrophic hormone (ACTH) and post-ACTH stimulation), serum aldosterone concentration post-ACTH stimulation and plasma endogenous ACTH concentration confirmed the diagnosis of isolated glucocorticoid-deficient hypoadrenocorticism. Following glucocorticoid supplementation, rapid resolution of the clinical signs was reported, and repeated conscious thoracic radiographs one week later showed complete resolution of the megaoesophagus.

OBJECTIVE To explore sources of serum aldosterone concentration variability in a population of healthy and diseased ferrets, determine a preliminary 1 -sided reference interval for serum aldosterone concentration in healthy ferrets, and identify a decision limit to differentiate healthy from diseased ferrets on the basis of serum aldosterone concentration. DESIGN Prospective threshold definition and diagnostic accuracy study. ANIMALS 78 healthy (n = 56) and diseased (22) ferrets. PROCEDURES Serum aldosterone concentrations were measured on consecutively admitted ferrets, and an upper reference limit for aldosterone concentrations was established. Sensitivity and specificity of aldosterone concentration cutoffs to differentiate healthy from diseased ferrets were estimated with receiver operating characteristic curve analysis. RESULTS Measurements of serum aldosterone concentrations in the ferrets showed wide variability, with a median concentration of 4.75 pg/mL (interquartile range, 0.55 to 17.9 pg/mL; range, 0.02 to 283.9 pg/mL) and 76% (59/78) of samples having concentrations < 18 pg/mL. Ferrets that were healthy, older, or sexually inactive had significantly lower aldosterone concentrations. The upper limit of the reference interval for healthy ferrets was 13.3 pg/mL (90% confidence interval, 9.9 to 16.9 pg/mL). Analysis of receiver operating characteristic curves indicated that an aldosterone concentration cutoff value of 7.6 pg/mL differentiated healthy ferrets from diseased ferrets with a sensitivity of 72.7% and specificity of 73.2% (area under the curve, 0.79; 95% confidence interval, 0.67 to 0.91). CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that high aldosterone concentrations should not be considered diagnostic of primary hyperaldosteronism in ferrets. A need exists to develop better tests to identify primary hyperaldosteronism.

BackgroundThis study aimed to examine the effect of pool walking on renal function in pregnant women.MethodsFifteen pregnant women (mean gestational age, 37.8 weeks) walked in a pool (depth 1.3 m) for 1 h. A few days later, they walked on a street for 1 h. Within each activity, the starting and ending levels of plasma renin activity (PRA) and serum aldosterone (SA) were compared using paired t-test. Total urine volume, creatinine clearance, and change in PRA levels between each activity were compared by t-test. Regression coefficients for total urine volume and creatinine clearance during pool walking were estimated by linear regression and additionally controlled for the change in PRA levels. Land walking served as the reference group.ResultsWithin each activity, the renin-angiotensin-aldosterone levels were suppressed during pool walking: the mean starting and ending values of PRA and SA were 6.8 vs. 5.5 ng/mL/h (p=0.002) and 654 vs. 473 pg/mL (p=0.02), respectively. Compared to land walking, the decrease in PRA level was more evident in pool walking (−1.27 vs. 0.81 ng/mL/h, p=0.004), resulting in higher total urine volume and creatinine clearance in pool walking (both pConclusionsPool walking may temporarily improve renal function in pregnant women, partly through the suppressed renin-angiotensin-aldosterone system.Clinical Trial RegistrationURL: https://upload.umin.ac.jp/cgi-bin/ctr/ctr_view_reg.cgi?recptno=R000010618Unique Identifier: UMIN000009051

Protein-losing enteropathy (PLE) is a rare and life-threatening complication that occurs after the Fontan procedure. We herein report the case of an 11-year-old Japanese boy who developed PLE six times after undergoing the Fontan procedure. High-dose spironolactone therapy has been effective for 2 years. His high level of serum aldosterone decreased to a nearly normal range and spironolactone may have a diuretic and anti-inflammatory potential.

Background: Accurate quantification of aldosterone is essential in the diagnosis of primary aldosteronism. Liquid chromatography-tandem mass spectrometry (LC-MSMS) analysis is increasingly being used to improve analytical sensitivity and specificity, since this technology reduces most of the interferences observed with immunological methods. Methods: Serum samples with d7-aldosterone as internal standard were extracted with methyl tert-butyl ether, using liquid-liquid extraction (LLE). Chromatographic separation was performed on a C18 reverse phase column with a methanol-water gradient containing ammonium fluoride. Aldosterone detection was performed on an Agilent 6490 triple quadrupole using electro spray ionisation in positive mode. Results: Multiple reaction monitoring transitions were m/z 361.2–315.1 for aldosterone, and 368.5–323.3 for d7-aldosterone. Chromatographic retention time was 2.7 min. The method’s total CVs at aldosterone concentrations of 45.4 and 1080 pmol/L were 7.0% and 4.8%, respectively. The intra-assay CVs at concentrations of 60.0 and 637 pmol/L were 4.0% and 2.6%, respectively. The method’s LOQ and LOD were 10 and 5 pmol/L, respectively, demonstrating an excellent analytical sensitivity. The upper limit of quantification was set to 5000 pmol/L, corresponding to the highest calibrator concentration. The long-term stability of the method was evident from repeated measurements of external control pools from UKNEQAS over a period of about 3 years, showing CVs between 2.0 and 7.0%. Conclusions: We have described a precise, sensitive and stable LC-MSMS method for the measurement of serum aldosterone. In addition, due to the use of LLE and a short LC-column, the method is simple to perform, with a short chromatographic run time.

Introduction: Noise exposure may have anatomical, nonauditory, and auditory influences. Considering nonauditory impacts, noise exposure can cause alterations in the automatic nervous system, including increased pulse rates, heightened blood pressure, and abnormal secretion of hormones. The present study aimed at examining the effect of various sound pressure levels (SPLs) on the serum aldosterone level among rats. Materials and Methods: A total of 45 adult male rats with an age range of 3 to 4 months and a weight of 200 ± 50 g were randomly divided into 15 groups of three. Three groups were considered as the control groups and the rest (i.e., 12 groups) as the case groups. Rats of the case groups were exposed to SPLs of 85, 95, and 105 dBA. White noise was used as the noise to which the rats were exposed. To measure the level of rats’ serum aldosterone, 3 mL of each rat’s sample blood was directly taken from the heart of anesthetized animals by using syringes. The taken blood samples were put in labeled test tubes that contained anticoagulant Ethylenediaminetetraacetic acid. In the laboratory, the level of aldosterone was assessed through Enzyme-linked immunosorbent assay protocol. The collected data were analyzed by the use of Statistical Package for Social Sciences (SPSS) version 18. Results: The results revealed that there was no significant change in the level of rats’ serum aldosterone as a result of exposure to SPLs of 65, 85, and 95 dBA. However, the level of serum aldosterone experienced a remarkable increase after exposure to the SPL of 105 dBA (P < 0.001). Thus, the SPL had a significant impact on the serum aldosterone level (P < 0.001). In contrast, the exposure time and the level of potassium in the used water did not have any measurable influence on the level of serum aldosterone (P = 0.25 and 0.39). Conclusion: The findings of this study demonstrated that serum aldosterone can be used as a biomarker in the face of sound exposure.

Item does not contain fulltext BACKGROUND: The aldosterone-to-renin ratio (ARR) is a widely used screening test for primary aldosteronism. Current guidelines recommend a cut-off value of 91 pmol/mU. Studies on its sensitivity, specificity, reproducibility and the role of medication have been conflicting. We prospectively assessed the test characteristics of the ARR and the effect of combination antihypertensive treatment. METHODS: In 178 patients with persistent hypertension despite the use of at least two antihypertensives, plasma renin and aldosterone were assessed twice within an interval of 4 weeks. All patients underwent an intravenous salt loading test. A posttest plasma aldosterone exceeding 235 pmol/l was considered diagnostic for primary aldosteronism. ARR was repeated after 4 weeks of standardized treatment with a calcium channel blocker and/or alpha-adrenergic-receptor blocker. RESULTS: The prevalence of primary aldosteronism was 15.2%. The median ARR was 35.0 (interquartile range 16.2-82.0) in primary aldosteronism versus 7.1 (2.2-17.5) pmol/mU in essential hypertensive patients (P < 0.001). Under random medication, the ARR had 22.2% sensitivity and 98.7% specificity. On standardized treatment, the ARR rose from 9.6 (2.5-24.8) to 21.4 (10.8-52.1) (P < 0.001). Multivariate regression showed that angiotensin-converting enzyme (ACE)-inhibitors and angiotensin II-receptor blockers were responsible for the lower ARR during random treatment. The area under the receiver operating characteristic curve was, however, similar under random and standardized treatment (84 vs. 86%, respectively, P = 0.314). Bland-Altman plots showed an almost five-fold difference in ARR values taken under the same conditions. CONCLUSION: ARR sensitivity for primary aldosteronism is low when the recommended cut-off is used. Reproducibility is also poor, stressing the need for alternative screening tests.

Hyperkalaemia is a clinically relevant electrolyte imbalance in neonatal diarrhoeic calves which was previously associated with severe dehydration and acidaemia. The present study assessed the association of plasma potassium (cK) with serum aldosterone and insulin concentrations, since these hormones are involved in the regulation of potassium homeostasis. Serum aldosterone (r(s)=0.62), but not insulin concentrations (r(s)=0.22) were closely correlated to cK in 123 hospitalised neonatal diarrhoeic calves. Median values for serum aldosterone concentrations in 38 hyperkalaemic calves (cK > 5.8 mmol/L) were 3.2 and 15.3 times higher (P < 0.001) than in 85 non-hyperkalaemic diarrhoeic calves and nine healthy control calves, respectively. Aldosterone, but not insulin secretion, appears to be highly stimulated in dehydrated diarrhoeic calves with hyperkalaemia, but hypovolaemia and a concomitant decrease in renal perfusion and urinary flow rate are likely to limit the efficacy of aldosterone-induced control mechanisms in these animals.

Background Occupational exposure to excessive noise is one of the biggest work-related challenges in the world. This phenomenon causes the release of stress-related hormones, which in turn, negatively affects cardiovascular risk factors. Objectives The current study study aimed to determine the level of workers’ serum aldosterone in light of the combined effect of sound pressure level, exposure time and serum potassium level. Methods This cross-sectional, descriptive, analytical study was conducted on 45 workers of Gol-Gohar Mining and Industrial Company in the fall of 2014. The subjects were divided into three groups (one control and two case groups), each including 15 workers. Participants in the control group were selected from workers with administrative jobs (exposure to the background noise). On the other hand, participants in the case groups were selected from the concentrator and pelletizing factories exposed to excessive noise. Serum aldosterone and potassium levels of participants were assessed at three different time intervals: at the beginning of the shift and before exposure to noise (7:30 - 8:00 AM), during exposure to noise (10:00 - 10:30 AM), and during continuous exposure (1:30 - 2:00 PM). The obtained data were transferred into SPSS ver. 18. Repeated measures analysis of variance (ANOVA) was used to develop the statistical model of workers’ aldosterone level in light of the combined effect of sound pressure level, exposure time, and serum potassium level. Results The results of the final statistical model to determine the level of serum aldosterone based on the combined effect of sound pressure level, exposure time and serum potassium level indicated that the sound pressure level had a significant influence on the human’s serum aldosterone level (P = 0.04). In addition, the effects of exposure time and serum potassium on aldosterone level were statistically significant with P-values of 0.008 and 0.001, respectively. Conclusions The obtained model in the study revealed that the results of predictive models to determine aldosterone level were very similar to real values; therefore, the obtained values of this model were largely in line with the ones obtained from the field.

The serum aldosterone concentration (SAC) to plasma renin activity (PRA) ratio (ARR) is considered a useful screening test in the differential diagnosis of essential hypertension (EH) and primary aldosteronism (PA). The purpose of this study is to investigate the variation of ARR and compare the screening efficiency of it under different postures. 37 patients with PA and 92 patients with EH were recruited in this study. Blood was sampled for measuring SAC and PRA under conditions of overnight recumbency, keeping upright posture for 1 h, 2 h and 4 h. The variation and screening efficiency of ARR under these conditions were compared according to repeated measured ANOVA and ROC curve analysis. In the EH group, ARR measured under recumbency posture was higher than those measured under keeping upright posture for 1 h and 2 h. In the PA group, there is no statistical difference for ARR between any 2 postures. AUCs of ARR measured under 4 conditions were 0.976, 0.995, 0.988, and 0.974 respectively. Cutoff values were ranging from 24.75 ng/dl per ng/ml/h under keeping upright for 2 h to 69.19 ng/dl per ng/ml/h under overnight recumbercy. ARR measured under keeping upright posture for 1 h produced the best characteristic of screening efficiency. Keeping upright posture for 1 h was the ideal position for ARR measuring and using a cutoff value of 35.90 ng/dl per ng/ml/h will have a sensitivity and specificity of 100.00% and 92.30% respectively.

In high-Na + , low-K + diets, which suppress renin release in salt-sensitive groups, the mechanisms maintaining increases in renin-angiotensin-aldosterone system activation downstream from renin and renin-angiotensin-aldosterone system–induced effects on blood pressure (BP) are uncertain. Whether circulating angiotensinogen concentrations (AGT) or its determinants may contribute to maintaining serum aldosterone concentrations (aldosterone) and increases in BP on high-Na + , low-K + diets was evaluated in 579 participants of a community sample of African ancestry. Plasma renin concentrations were inversely related to BP ( P + /K + , P + /K + was independently associated with aldosterone ( P P + /K + at or more than the median for the sample, AGT was positively associated with aldosterone ( P P + /K + less than the median for the sample. Standardized β-coefficients (slopes) of AGT-aldosterone and AGT-SBP relationships were greater in participants with urinary Na + /K + at or more than the median (AGT-aldosterone=0.30±0.06, AGT-SBP=0.16±0.05) compared with those with urinary Na + /K + less than the median (AGT-aldosterone=−0.04±0.06; AGT-SBP=−0.03±0.05; P + /K + at or more than the median for the sample was equivalent to the relationship between body mass index and BP. In conclusion, in participants of African ancestry, in the presence of high-Na + , low-K + diets, which suppress renin release, renin-angiotensin-aldosterone system activation and its impact on BP are maintained in part by AGT.

The objective of this study was to examine the extent to which aldosterone synthase genotype (CYP11B2) and genetic ancestry correlate with atrial fibrillation (AF) and serum aldosterone in African Americans with heart failure. Clinical data, echocardiographic measurements, and a genetic sample for determination of CYP11B2 -344T>C (rs1799998) genotype and genetic ancestry were collected from 194 self-reported African Americans with chronic, ambulatory heart failure. Genetic ancestry was determined using 105 autosomal ancestry informative markers. In a sub-set of patients (n = 126), serum was also collected for determination of circulating aldosterone. The CYP11B2 -344C allele frequency was 18% among the study population, and 19% of patients had AF. Multiple logistic regression revealed that the CYP11B2 -344CC genotype was a significant independent predictor of AF (OR 12.7, 95% CI 1.60-98.4, p = 0.0150, empirical p = 0.011) while holding multiple clinical factors, left atrial size, and percent European ancestry constant. Serum aldosterone was significantly higher among patients with AF (p = 0.036), whereas increased West African ancestry was inversely correlated with serum aldosterone (r = -0.19, p = 0.037). The CYP11B2 -344CC genotype was also overrepresented among patients with extreme aldosterone elevation (≥90th percentile, p = 0.0145). In this cohort of African Americans with chronic ambulatory heart failure, the CYP11B2 -344T>C genotype was a significant independent predictor of AF while holding clinical, echocardiographic predictors, and genetic ancestry constant. In addition, increased West African ancestry was associated with decreased serum aldosterone levels, potentially providing an explanation for the lower risk for AF observed among African Americans.

The existing literature indicates that occupational exposure to noise may have adverse effects on workers′ health. The aim of this study was to evaluate the possible effects of exposure to different sound pressure levels (SPLs) on serum aldosterone and potassium concentration among Iranian blue collar workers in Golgohar Mining and Industrial Company in Sirjan, Kerman Province, Iran. This case-control study was performed on 45 workers of Golgohar Mining and Industrial Company. The subjects consisted of 30 workers from manufacturing departments and 15 office employees of the mining company. The controls, mainly with administrative jobs were exposed to 72 dBA SPL. Cases, in two separate groups, were exposed to noise levels of 88 dBA and 103 dBA, respectively. Noise intensity was measured at the desired locations. Noise measurements were performed according to the International Organization for Standardization (ISO) 9612. To measure the serum aldosterone and potassium concentrations, a 5 mL blood sample was taken from each worker at the specified time intervals and aldosterone concentration was determined using enzyme-linked immunosorbent assay (ELISA) test in the laboratory. Repeated measurement and Spearman′s correlation coefficient analysis were used with α = 0.05. Exposure to the different levels of sound pressure resulted in different aldosterone concentrations and meanwhile an increase in the SPL did not affect the concentration of potassium. From 10:00 AM to 10:30 AM, as SPL increased, aldosterone concentrations did not increase significantly but from 13:30 PM to 14:00 PM, raised SPL led to a significant increase in aldosterone concentration. However, there was no correlation between the concentration of potassium and different factors. This study indicated that increases in SPLs affect aldosterone concentration but at the same time do not have significant effects on serum potassium level.

We thank Drs Keidar and Gamliel-Lazarovich for their very thoughtful comments regarding our study. We agree that it would be of interest to have been able to relate serum aldosterone levels to changes in clinic and ambulatory blood pressures after LCI699 administration.1 However, given the size and design of our study, we were not able to obtain the frequency of sampling of serum aldosterone necessary to precisely relate blood pressure changes to peak-and-trough medication effects on aldosterone. In addition, …

The present work studied the annual and daily aldosterone, norepinephrine and epinephrine patterns in the newt Triturus carnifex. The annual variations of the serum aldosterone were evaluated every month by radioimmunoassay, from September to July; the daily variations of this hormone were evaluated in the months of January, April, July and November. Aldosterone levels were low from September to November (lowest value 187.23 ± 19.7 pg/ml in November), increased in December, remained high until March and peaked in April (587.25 ± 58.2 pg/ml). In May, the levels decreased and remained steady until July. Considering the daily aldosterone pattern, in all the examined months, serum aldosterone levels were lowest at 5:00 am (lowest value 162.51 ± 17.4 pg/ml in November) and peaked at 5:00 pm (maximal value 2075.00 ± 213.00 pg/ml in April). As regards the annual catecholamine pattern as measured by HPLC, serum norepinephrine levels were low from September to November (lowest value 541.13 ± 39.8 pg/ml in September), increased in December, peaked in January (1457.03 ± 106.97 pg/ml) and remained high in February. In March, the levels decreased and remained steady until June, then decreased in July. Serum epinephrine levels increased from September to November, decreased in December and remained low until February. In March, the levels increased and peaked in April (721.55 ± 49.91 pg/ml), then decreased (lowest value 140.00 ± 10.0 pg/ml in June) and remained steady until July. Considering the daily catecholamines levels, in all the examined months, there were no daily variations among serum norepinephrine levels. Otherwise, serum epinephrine levels were always lowest at 5:00 am (lowest value 100.77 ± 9.9 pg/ml in January) and peaked at 11:00 pm (maximal value 3831.05 ± 211.5 pg/ml in November). The annual and daily aldosterone and catecholamine patterns appear correlated to the metabolic activity of this species.

A growing body of evidence suggests that hyperaldosteronism contributes significantly to the development and the severity of hypertension as well as to resistance to antihypertensive treatment. In cross-sectional analyses, plasma aldosterone levels have been shown to relate to BP levels, particularly in obese individuals. In these same individuals, BP was not related to plasma renin activity, suggesting an effect of aldosterone on BP independent of renin–angiotensin II. In a recent prospective analysis from the Framingham investigators, baseline serum aldosterone was strongly associated with development of hypertension during a 4-yr follow-up.

The pathogenesis of edema in nephrotic syndrome has not been entirely understood. We investigated the value of the echographic parameters [inferior vena cava index (IVCI), inferior vena cava collapsibility index (IVCCI), and left atrium diameter (LAD)] to determine the volume load in children with minimal lesion nephrotic syndrome (MLNS). Twelve children with MLNS (seven boys, five girls) were included in this study. The patients were classified into three different stages (stage A: edematous; stage B: 50% decrease in weight gain; stage C: edema free) following measurement of their ideal weights. The ideal weight of patients in stage A was increased 13 +/- 7%. Serum total protein, albumin and urine sodium levels were found to be low in these patients. Plasma renin activity (PRA) and serum aldosterone levels in stage A were significantly different from those of the control group (P0.05). PRA and serum aldosterone levels were not different from those of the control group in stage B (P0.05). However, the increase in PRA was significant in stage C. Although a significant weight decrease was found in stages B and C, it had no effect on IVCI, LAD, and cardiothoracic index. We consider IVCI, IVCCI, and LAD measurements by echocardiography (ECHO) to be easy and reliable clinical methods for assessing the intravascular volume load in patients with MLNS.

increased ( PRA supine 4.2 ng/ml/h with n.v. 0.2‐2.8 ng/ml/h; PRA standing 8.0 ng/ml/h with n.v. 1.5‐5.7 ng/ml/h; serum aldosterone supine 230 pg/ml with n.v. 30‐150 pg/ml; serum aldosterone standing Case Report 393 pg/ml with n.v. 70‐350 pg/ml ), in spite of normal values of both serum and urinary sodium and potassium in two collections (142.2 mEq/l and 4.14 mEq/l A 16-year-old girl was admitted to the Division of with 142.4 mEq/24 h and 50.3 mEq/24 h respectively

Objectives To analyse the relationship between 24 h-urine protein level and serum aldosterone concentration in aldosterone-producing adenoma (APA) patients. Methods Data of 32 APA patients who were confirmed by postoperative pathological diagnose were collected in the hypertension department of the people9s hospital of Xinjiang Uygur autonomous region form June 2006 to March 2010. The patients were divided into three groups according to the tertile of serum aldosterone concentration (≤14.95 ng/dl, 14.96 ng/dl–24.71 ng/dl and ≥24.72 ng/dl). The 24 h-urine protein level of three groups were compared. Furthermore, the relationship between 24 h-urine protein level and serum aldosterone concentration were analysed. Results 1. Compared with the patients in the first (Lg (24 h-urine protein level): 0.87±0.28 g/24 h) and the second group (Lg (24 h-urine protein level): 1.09±0.27 g/24 h), the patients in the third group (Lg (24 h-urine protein level): 1.51±0.50 g/24 h) had higher 24-proteinuria levels (p 2. The Pearson correlation analysis showed that 24-h urine protein level was remarkably positively correlated with the serum aldosterone concentration in APA patients. (r=−0.491, p Conclusions The proteinuria of the APA patients was positively correlated with the serum aldosterone concentration.

A novel inhibitor of aldosterone synthase, LCI699, safely reduces serum aldosterone levels, as well as clinic and ambulatory blood pressure in patients with primary hypertension. “Aldosterone, in combination with high dietary salt, [is] an important mediator of target-organ damage, including endothelial function, cardiac hypertrophy, and renal disease,” says Professor David Calhoun, lead author of a report on a phase II trial of LCI699.

1demonstrating an association between the metabolic syndrome and the existence of pulmonary venous hypertension. Recent research has also demonstrated an association between serum aldosterone, a known cause of left ventricular dysfunction and remodeling, and the metabolic syndrome. 2 - 4 Thus, it is possible that increased circulating aldosterone might be independently associated with the risk for pulmonary venous hypertension. Do the authors have data examining aldosterone or renin activity in their subjects?

Testicular adrenal-like tissue (TALT) have been observed in patients with congenital adrenal hyperplasia, and is usually associated with 21-hydroxylase deficiency; in 3 cases with 11 beta-hydroxylase deficiency. We report a case of male pseudohermaphroditism with 17 alpha-hydroxylase deficiency (17OHD) who also had TALT. To our knowledge, this is the first report about the association of 17OHD and TALT. Also, the patient had high levels of serum aldosterone--an unusual finding in patients with 17OHD. A possible pathogenic mechanism is discussed.

OBJECTIVE—An association between aldosterone and insulin resistance has been demonstrated in obesity and primary aldosteronism and in blacks with the metabolic syndrome. The aim of this study was to evaluate the relationship of plasma aldosterone with insulin sensitivity in white subjects. RESEARCH DESIGN AND METHODS—In 356 patients with essential hypertension and 102 normotensive control subjects of comparable age and BMI, we measured, after discontinuation of treatment, plasma active renin, aldosterone, cortisol, glucose, insulin, and C-peptide levels and calculated markers of insulin sensitivity. Direct assessment of insulin sensitivity was obtained in a subset of 64 hypertensive patients by a hyperinsulinemic clamp. RESULTS—Hypertensive patients had significantly greater fasting plasma insulin and C-peptide concentrations and homeostasis model assessment (HOMA) indexes than normotensive control subjects. A positive association with increasing plasma aldosterone concentrations was demonstrated for plasma glucose, insulin, C-peptides, and HOMA. Assessment of insulin sensitivity by clamp showed a significant decrease of the metabolic clearance rate of glucose with increasing aldosterone levels. Significant correlations were found between plasma aldosterone, plasma insulin, and C-peptide levels, HOMA, and glucose metabolic clearance rate. Blood pressure and plasma potassium, plasma cortisol, and renin levels, but not BMI, were also directly correlated with plasma aldosterone. Multiple regression analysis showed that HOMA, together with plasma potassium, cortisol, and renin levels, was independently correlated with plasma aldosterone. CONCLUSIONS—This study demonstrates a direct relationship between aldosterone, insulin resistance, and hyperinsulinemia in white subjects. In patients with hypertension, this relationship might contribute to maintenance of high blood pressure and increased cardiovascular risk.

1. Riboflavin analogues were tested in three hypertensive rat models: the DOCA-salt hypertensive rat, spontaneously hypertensive rats (SHR) and Dahl S rats. 2. When 1.6 mg of 7,8-dimethyl-10-formyl-methylisoalloxazine (FMI) or 7,8-dimethyl-10-(2′-hydroxyethyl)isoalloxazine (HEI) was administered with 3.0 mg of DOCA twice weekly for 9 weeks, the systolic blood pressure (SBP) of the unanaesthetized rats rose to only 136 ± 5 mmHg compared with 165 ± 5 mmHg during DOCA treatment alone. The analogues blunted the retention of iliopsoas muscle Na+ and water due to DOCA. 3. In subsequent studies, the more potent riboflavin analogue 7,8-dimethyl-10-(3-chlorobenzyl)isoalloxazine (CBI) was employed. Administration of 0.5 mg of CBI/100 g body wt. twice weekly for 7 weeks lowered the SBP of the unanaesthetized SHR from 188 ± 7 mmHg to 148 ± 2 mmHg. The rats tolerated the medication well. CBI was more effective than hydrochlorothiazide, which at 2.2 mg/100 g body wt. daily only lowered the SBP to 167 ± 5 mmHg. The combined administration of CBI and hydrochlorothiazide produced an additive effect in that the SBP was reduced to 126 ± 4 mmHg. 4. CBI treatment resulted in a 36% and 11% decrease in the iliopsoas muscle Na+ concentration and water content respectively, suggesting that the untreated SHR is retaining Na+. The hydrochlorothiazide-treated SHR exhibited elevated levels of serum aldosterone. There was a profound suppressive effect of CBI on the secondary hyperaldosteronism generated by hydrochlorothiazide which was also reflected in the iliopsoas muscle K+ concentration. 5. In contrast to the SHR, the administration to the Dahl S rats of CBI for 8 weeks at 0.5 mg/100 g body wt. twice weekly reduced neither their SBP nor their iliopsoas muscle Na+ and water contents. 6. These results are consistent with our hypothesis that the antihypertensive actions of the riboflavin analogues are closely associated with their ability to modify the effects of mineralocorticoids on Na+ balance. These data suggest that riboflavin analogues also decrease aldosterone production and may function as dual-mechanism diuretic agents with K+ sparing properties and thus act as a novel class of antihypertensive drugs.

A simplified direct radioimmunoassay system for serum aldosterone measurement was developed by using radio iodine-labeled aldosterone and highly specific antiserum to aldosterone. 8-anilino-1-naphthalene sulfonic acid(ANS) was used to prevent the binding of aldosterone to serum proteins. Polyethylene glycol was used to separate the antibody-bound aldosterone from the free aldosterone as the precipitant. The minimum measurable concentration of aldosterone is 30pg/ml of serum by short incubation method (at 25 degrees C for 3hr incubation) and 15pg/ml of serum by long incubation method (at 4 degrees C for 20 hr incubation) respectively. Present radioimmunoassay eliminates extraction of the aldosterone from serum and chromatographic separation procedures, and requires only 0.1ml of serum sample for assay. The intra-assay precision was C. V. 6.9% (average of 4 samples) and the inter-assay precision was C. V. 10.7% (average of 4 samples). There is an excellent correlation between the extraction method and this direct method in serum aldosterone value obtained (correlation coefficient, 0.96). The normal value was 36.8+/-25.9pg/ml (recumbent) and 113.6+/-6.15pg/ml (upright).

SUMMARY We report two children of a family with congenital adrenocortical unresponsiveness to ACTH. Repeated stimulation of the adrenal by Synthetic 1–24 ACTH (Synacthen) failed to increase cortisol secretion, but produced significant rises of serum aldosterone. This was, however, associated with increased plasma renin activity. Only when the renin-angiotensin effect was eliminated, by a converting enzyme blocker, did Synacthen fail to affect serum aldosterone. These data support the view that glucocorticoid deficiency in this disorder results from unresponsiveness to ACTH and that development of the zona glomerulosa and normal aldosterone secretion is achieved by action of the renin-angiotensin system.

The effects of pulsatile cardiopulmonary bypass on the renin-angiotensin-aldosterone system and tissue metabolism, especially those which occur soon after surgery, were studied in 26 patients who required total cardiopulmonary bypass for longer than 60 minutes. These patients comprised 11 who underwent open heart surgery utilizing nonpulsatile cardiopulmonary bypass (Group I) and 15 who underwent open heart surgery utilizing pulsatile cardiopulmonary bypass (Group II). Plasma angiotensin II and serum aldosterone levels were significantly increased one and 5 hours postoperatively in Group I when compared with the preoperative values, whereas no significant elevations were observed in Group II. Plasma angiotensin II and serum aldosterone levels one hour postoperatively in Group II were significantly lower than those in Group I. Lactate levels in the arterial blood were significantly elevated, one and 5 hours postoperatively in both Groups I and II. Moreover, no significant difference was observed in the lactate levels between Groups I and II, one hour postoperatively. In the nonpulsatile group (Group I), plasma angiotensin II levels one hour postoperatively were correlated significantly with the duration of total cardiopulmonary bypass. In conclusion, pulsatile cardiopulmonary bypass offers significant advantages in terms of lower plasma angiotensin II and serum aldosterone levels, when compared with nonpulsatile cardiopulmonary bypass soon after open heart surgery requiring total cardiopulmonary bypass for longer than 60 minutes, however, it does not offer a definite advantage for tissue metabolism.

Beta-receptor agonist (terbutalin or isoxsuprin) administration to pregnant women either because of premature labor (therapy group; T; n = 8) or as prophylactic treatment (prophylaxis group; p; n = 8) resulted in a marked drop in serum potassium (p less than 0.001) during the first two hours of infusion in all patients. In five diabetic women in the P group the prolactin was significantly decreased (P less than 0.01) as was serum aldosterone levels (p less than 0.01). These changes were not observed in the T group. The two groups of pregnant women responded with a significant increase in free fatty acids (FFA) and glucose but the magnitude and the time coarse differed. Thus in T women, FFA reached a peak after 30-60 minutes into treatment and then returned to baseline levels. A closer analysis revealed that this pattern was only obtained in patients receiving terbutalin. Among women given prophylactic treatment with terbutalin, a continuous increase in FFA was noted over the initial two hours (p less than 0.001). The increase in serum glucose was continuous in the two patient groups (p less than 0.001). It is suggested that beta-receptor agonists in diabetic women induces a dopaminergic type of response since serum prolactin levels but not TSH concentrations were affected. The possibility that an increased PGE2 synthesis at the expense of PGF2 alpha might mediate this effect of beta-receptor agonists in discussed. It is also suggested that an increased prostaglandin synthesis might interfere with aldosterone secretion. The possibility that falling serum potassium levels may activate dopaminergic systems via PGE2 synthesis is also emphasized.

Rats were fed 47 (deficient) and 606 ppm (adequate) magnesium with either 2,100 or 14,000 ppm sodium. Serum corticosterone and aldosterone levels were determined by randoimmunoassay in six rats from each treatment group killed on days 7, 14, and 28 of consumption of the experimental diets. Serum corticosterone levels were moderately, but not significantly, decreased in magnesium deficient animals. Serum aldosterone levels increased over time in the rats fed the lower sodium diet with adequate magnesium and were further elevated in magnesium deficient animals. In sodium loaded rats the increase in aldosterone levels in magnesium deficiency was less and occurred later. Retention and urinary excretion of sodium and potassium did not appear to be affected by magnesium status or the serum concentration of aldosterone. Possible mechanisms underlying the changes in aldosterone levels of magnesium depleted animals are discussed with reference to the known effects of magnesium deficiency on physiological functions.

Xenopus laevis adult females exposed to progressive water deprivation and maintained under dry conditions for two weeks showed a statistically significant increase in serum aldosterone and cortico‐sterone levels in response to osmotic stress. These results are in accordance with those previously obtained by us in males from this typically aquatic species subjected to the same experimental conditions. In females returned to water for one week after a two week period of dehydration, serum aldosterone and corticosterone returned to values approximating those of control.

Summary The specific activity of mucosal Na-K-ATPase in segments of the small intestine and colon was examined after bilateral nephrectomies (BN), bilateral upper ureteral ligations (BUUL) and bilateral lower ureteral ligations (BLUL). Animals were studied 22–26 h after these respective operations. Bilateral nephrectomies and bilateral upper ureteral ligations resulted in an increase of the specific activity of the enzyme throughout the mucosa of the intestinal tract. Bilateral lower ureteral ligations induced no significant change in the specific activity of Na-K-ATPase in the intestinal mucosa. There were no differences in the degree of renal failure. Marked aldosteronemia was observed in the BN and the BUUL rats but not in the BLUL rats. These data suggest that the increase in the intestinal Na-K-ATPase activity in the BN and the BUUL rats may be related to the elevation of serum aldosterone as a regulator of the body potassium.

Serum aldosterone values were determined in 6 elderly (70-82 years) and in 6 adult (31-43 years) male subjects after the intravenous administration of 10 mg of metoclopramide. A significant difference in the metoclopramide-induced serum aldosterone rise was found between the two groups, it being blunted in the older subjects (serum aldosterone peak values: 15.8 +/- 3.6 ng/dl and 38.7 +/- 4.9 ng/dl in elderly and in adult subjects, respectively). The existence of an impaired aldosterone secretion in response to dopaminergic blockade in the elderly is postulated.

A shortened, simplified radioimmunoassay for serum aldosterone has been made possible by the development of a highly specific antiserum for aldosterone. This high specificity is largely due to the careful purification of the aldosterone-3-oxime derivative. Using 50% displacement of 1,2-3H-aldosterone as a measure, no other steroid cross-reacts to a degree greater than 0.015% (18-OH-DOC) and most cross-react less than 0.00003%. Recovery, accuracy and sensitivity are quite satisfactory using only serum extraction with methylene chloride and no further separation. The normal range found is comparable with others reported (3–35 ng/100 ml) although women are shown to have more variable levels than men.

1. Deoxycorticosterone acetate (DOCA) implantation (100 mg/kg) caused mean arterial pressure to rise in 5–10 days from control pressures of 100–115 mmHg to stable hypertensive valnes of 140–160 mmHg in approximately 1 month. In six of seven pigs elevations of mean arterial pressure were entirely the result of increased total peripheral resistance. 2. Single implants maintained serum DOCA at approximately ten times normal concentration for up to 90 days. 3. Moderate but variable decreases in serum aldosterone followed implantation. 4. Hypokalaemia, polydipsia and suppressed plasma renin activity were evident by the fifth post-implantation day and persisted thereafter. No consistent change occurred in serum sodium. 5. Noradrenaline or angiotensin caused increases in total peripheral resistance at lower threshold infusion rates in hypertensive pigs compared with control animals. 6. In isolated, perfused hind-limb preparations, hypertensive vascular beds were characterized by both functional (increased vascular smooth muscle sensitivity) and structural (elevated resistance of maximally dilated vascular bed) changes. ‘Protection’ from increased arterial wall stresses in hypertensive pigs prevented structural, but not functional, alterations.

SUMMARY The effect of L-dopa (0·50 g, orally) on serum aldosterone, cortisol and potassium levels, plasma renin activity, and on urinary aldosterone excretion has been studied in normotensive subjects, before and after dexamethasone-induced ACTH suppression. L-dopa caused a further reduction in the levels of aldosterone but not cortisol, in the dexamethasone treated subjects. It is therefore suggested that the inhibitory action of L-dopa on aldosterone secretion is mediated by the dopaminergic system.

Previous studies have shown that increased sodium chloride in drinking water failed to suppress serum renin activity (SRA) in the ether-anesthetized rat. In the absence of anesthesia, sodium chloride decreased SRA by 76%SS and serum aldosterone by 72%. Deoxycorticosterone acetate, when given alone, produced similar results but was more effective in reducing SRA (96%) when com-bined with sodium chloride. However, if “light” ether anesthesia was administered prior to blood collection, there was a 10-fold increase in SRA and the effects of sodium chloride were blocked. Thus, n i the absence of anesthesia, the renin-angiotensin-aldosterone system of the rat responds, as in other species, to a sodium load.(Endocrinology 97: 1394, 1975)

Two antibody method of aldosterone RIA kit was investigated. This kit was measured directly without extracting the aldosterone. On fundamental studies, stability of standard curve, reproductivity, recovery test and dilution test were obtained good results. On clinical studies, the diurnal variation of serum aldosterone concentration in normal child and adult was correlated well to that of concentration of cortisol and ACTH. The concentration of three hormones was the highest in the early morning and it was the lowest in midnight.

Nine 20- to 26-year-old and ten 70- to 78-year-old diurnally active, nocturnally resting women in Wurzburg, Federal Republic of Germany, gave blood at 0700, 1000, 1300, 1600, 1900, and 2200 for radioimmunoassay of aldosterone. Single and population-mean cosinors were applied. A multivariate analysis of circadian rhythm characteristics revealed effects of age on the amplitude (p = .003) but not the mesor of aldosterone in women (i.e., the age effect could only be detected at certain circadian times but not at others). No change with age was found for concomitantly sampled men. Statistically significant interactions among circadian time, age, and sex (p = .001) establish the adrenocorticopause in women and suggest that it may occur earlier in women than in men, in keeping with similar results on serum cortisol in the same subjects. This phenomenon awaits scrutiny from the viewpoint of its bearing on longevity and life quality. These results also indicate the importance of assessing chronobiological characteristics.