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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.

Background This study aimed to quantify and compare serum aldosterone (sALD) levels through three different chemiluminescence immunoassays (CLIAs) and liquid chromatography tandem mass spectrometry (LC-MS/MS) analysis. Methods Serum samples from 221 patients with suspected primary aldosteronism (PA) were retrospectively included in this study conducted at the Peking Union Medical College Hospital from June to August in 2017. sALD levels were determined using the LC-MS/MS method and three different CLIA systems, viz., DiaSorin® XL, iSYS and Auto Lumo A2000. Pooled fresh serum samples were used for recalibration. Passing-Bablok regression analysis, correlation matrix, and Bland-Altman plots were used to evaluate the concurrence among ALD levels determined using the three CLIAs. Results Within-laboratory precision of the four assays ranged from 2.1% to 9.4%, except the coefficient variation (CV) of one of the CLIAs, which exceeded 20.0% for samples with low sALD levels. sALD levels determined using LC-MS/MS were significantly lower than those determined using the other three CLIAs (p ® XL/iSYS. Conclusions Significant inconsistencies between the results of CLIAs and LC-MS/MS indicate that different sALD measures cannot be used interchangeably.

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, …

Accurate serum aldosterone determination is critical to the screening and diagnosis of primary aldosteronism, the localisation of aldosterone producing tumours, and the investigation of other disorders of the renin-angiotensin system. Mass spectrometry offers a means to overcome problems with method-dependent bias between competitive immunoassays for aldosterone. The authors have developed a simple, sensitive and precise liquid-liquid extraction aldosterone method for the ABSCIEX API-5000 liquid chromatography and tandem mass spectrometry (LC-MS/MS) system.Using d7-aldosterone internal standard, 500 μl of sample is extracted with 2500 μl of methyl tertbutyl ether followed by dry-down, reconstitution and LC-MS/MS analysis in ESI negative mode. Method validation was undertaken using standard approaches and comparison made against a commercial radioimmunoassay. Accuracy was assessed using EQA material with assigned aldosterone concentrations.The assay was linear up to 3420 pmol/l (LOQ=50 pmol/l, LOD22 pmol/l). Total CVs were ≤5% for concentrations ≥120 pmol/l and 10% at the LOQ. Mean accuracy was 98.5% against GCMS assigned material.The authors present a precise, sensitive and simple aldosterone method suitable for routine clinical use that requires no solid phase extraction or specialised ion sources.

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.