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Evidence of prostacyclin deficiency in the syndrome of hyporeninemic hypoaldosteronism

, : Evidence of prostacyclin deficiency in the syndrome of hyporeninemic hypoaldosteronism. New England Journal of Medicine 314(16): 1015-1020

Hyporeninemic hypoaldosteronism is an important cause of hyperkalemia and is characterized by low renin secretion. We found that prostacyclin, a potent vasodilator and renin secretagogue, was markedly reduced--as reflected by its stable urinary metabolite 6-keto-prostaglandin F1 alpha--in seven patients with hyporeninemic hypoaldosteronism as compared with seven matched controls with renal insufficiency and as compared with 12 normal volunteers (mean +/- SE, 42 +/- 7 vs. 185 +/- 37 and 164 +/- 20 ng per gram of creatinine, respectively; P less than 0.001). In contrast, renal prostaglandin E2 excretion was similar in all three groups. A low-dose infusion of calcium or norepinephrine (known stimulants of prostacyclin) increased renal prostacyclin release in normal subjects and controls with renal insufficiency. Neither agonist, however, increased the low basal prostacyclin excretion in the patients (49.6 +/- 11 [basal] vs. 62 +/- 20 [norepinephrine] and 47.5 +/- 16 [calcium]; P greater than 0.8). To evaluate the functional importance of the altered prostacyclin production, we studied the responses of renal blood flow and blood pressure to the calcium infusion. The calcium infusion did not alter blood pressure or renal blood flow in the normal subjects or the controls with renal insufficiency. In contrast, the same dose of calcium in the patients with hyporeninemic hypoaldosteronism produced a rise in mean blood pressure (from 91 +/- 6 to 104 +/- 8 mm Hg, P less than 0.05) and a fall in renal blood flow (from 673 +/- 58 to 560 +/- 42 ml per minute per 1.73 m2, P less than 0.05). These results indicate that a deficiency of prostacyclin could explain the low active-renin concentration and altered vasomotor tone seen in hyporeninemic hypoaldosteronism.

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Accession: 005411678

PMID: 3515183

DOI: 10.1056/NEJM198604173141604

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Related references

Horton R., 1985: Evidence for prostacyclin deficiency in hyporeninemic hypoaldosteronism. Clinical Research: 98a

Horton R., 1985: Hyporeninemic hypoaldosteronism a prostacyclin deficiency. Clinical Researchpart 1: 587a

Kalin, M.F.; Poretsky, L.; Seres, D.S.; Zumoff, B., 1987: Hyporeninemic hypoaldosteronism associated with acquired immune deficiency syndrome. Four patients with the acquired immune deficiency syndrome (AIDS) and persistent unexplained hyperkalemia were studied. Testing with cosyntropin (0.25 mg intravenously) revealed normal baseline and stimulated cortisol levels and adequate aldostero...

Windeck, R.; Brodde, O.E., 1988: Stimulation of the renin-aldosterone system by prostacyclin infusion in hyporeninemic hypoaldosteronism. Medizinische Klinik 83(8-9): 289-291

Okada, K.; Takahashi, S., 1996: A case of isolated ACTH deficiency with hyporeninemic hypoaldosteronism. A case of isolated ACTH deficiency with hyporeninemic hypoaldosteronism, presenting severe hyponatremia, is described. A 57-year-old man complaining of nausea, vomiting and fatigability was admitted to our hospital because of hyponatremia (114 mEq...

Yang, C.S.; Lee, S.H.; Hung, S.S., 1984: The syndrome of hyporeninemic hypoaldosteronism. Taiwan Yi Xue Hui Za Zhi. Journal of the Formosan Medical Association 83(6): 585-591

Knochel, J.P., 1979: The syndrome of hyporeninemic hypoaldosteronism. Annual Review of Medicine 30: 145-153

Manser, T.J.; Estep, H., 1986: Pseudo-Addison's disease. Isolated corticotropin deficiency associated with hyporeninemic hypoaldosteronism. A 60-year-old man presented with loss of weight and appetite, eosinophilia, and hyperkalemia consistent with a diagnosis of Addison's disease. Adrenal responsiveness to exogenous corticotropin was normal, but endogenous corticotropin and cort...

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