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Association of Hypotension With Hyperreninemic Hypoaldosteronism in the Critically Ill Patient

Association of Hypotension With Hyperreninemic Hypoaldosteronism in the Critically Ill Patient Abstract • Paradoxical suppression of plasma aldosterone (PA) despite increased plasma renin activity (PRA) has recently been noted in some critically ill patients. To determine the prevalence of this entity and to identify possible etiologic factors, we studied 100 consecutive patients admitted to a medical intensive care unit (ICU). Twenty-two of 100 ICU patients had hyperreninemia and inappropriately reduced PA concentrations, with a PA to PRA ratio less than the 98th percentile of the control population. Comparison of clinical data of these 22 patients with the other hyperreninemic ICU patients revealed no differences in electrolyte concentrations, nutrition, medications, or survival. However, persistent hypotension was much more frequent (91% v 53%). Thus, impaired aldosterone response to hyperreninemia has a high prevalence among critically ill patients and may be related to adrenal damage from persistent hypotension. (Arch Intern Med 1983;143:735-737) References 1. Laragh JH, Angers M, Kelly WG, et al: Hypotensive agents and pressor substances: Effect on the secretory role of aldosterone in man. JAMA 1960;174:234-240.Crossref 2. Genest J, Biron P, Koiw E, et al: Adrenocortical hormones in human hypertension and their relation to angiotensin. Circ Res 1961;9:775-791.Crossref 3. Ulick S, Gautier E, Vetter KK, et al: An aldosterone biosynthetic defect in a salt-losing disorder. J Clin Endocrinol Metabol 1964;24:669-672.Crossref 4. Biglieri EG, Slaton PE, Silen WS, et al: Postoperative studies of adrenal function in primary aldosteronism. J Clin Endocrinol Metabol 1966;26:553-558.Crossref 5. Laragh JH, Stoerk HC: On the mechanism of the sodium-retaining hormone (aldosterone). J Clin Invest 1957;36:383-392.Crossref 6. Zipser RD, Davenport MW, Martin KL, et al: Hyperreninemic hypoaldosteronism in the critically ill: A new entity. J Clin Endocrinol Metabol 1981;53:867-873.Crossref 7. Ito T, Woo J, Haning R, et al: A radioimmunoassay for aldosterone in human peripheral plasma including a comparison of alternate techniques. J Clin Endocrinol Metabol 1972;34:106-112.Crossref 8. Haber E, Koerner T, Page L: Application of a radioimmunoassay for angiotensin I to the physiologic measurements of plasma renin activity in normal subjects. J Clin Endocrinol Metabol 1969;29:1349-1355.Crossref 9. Kao M, Viona S, Nichols A, et al: Parallel radioimmunoassay for plasma cortisol and 11-deoxycortisol. Clin Chem 1975;21:1644-1647. 10. Liddle GW, Duncan Jr LE, Bartter FC: Dual mechanism regulating adrenocortical function in man. Am J Med 1956;21:380-386.Crossref 11. Matsuoka H, Mulrow PJ, Franco-Saenz R, et al: Effect of B-lipotropin and B-lipotropin derived peptides on aldosterone production in the rat adrenal gland. J Clin Invest 1981;68:752-759.Crossref 12. Carey RM, Thorner MO, Ortt EM: Effect of metoclopramide and bromocriptine on the renin-angiotensin-aldosterone system in man. J Clin Invest 1979;63:727-735.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Association of Hypotension With Hyperreninemic Hypoaldosteronism in the Critically Ill Patient

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Publisher
American Medical Association
Copyright
Copyright © 1983 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1983.00350040125016
Publisher site
See Article on Publisher Site

Abstract

Abstract • Paradoxical suppression of plasma aldosterone (PA) despite increased plasma renin activity (PRA) has recently been noted in some critically ill patients. To determine the prevalence of this entity and to identify possible etiologic factors, we studied 100 consecutive patients admitted to a medical intensive care unit (ICU). Twenty-two of 100 ICU patients had hyperreninemia and inappropriately reduced PA concentrations, with a PA to PRA ratio less than the 98th percentile of the control population. Comparison of clinical data of these 22 patients with the other hyperreninemic ICU patients revealed no differences in electrolyte concentrations, nutrition, medications, or survival. However, persistent hypotension was much more frequent (91% v 53%). Thus, impaired aldosterone response to hyperreninemia has a high prevalence among critically ill patients and may be related to adrenal damage from persistent hypotension. (Arch Intern Med 1983;143:735-737) References 1. Laragh JH, Angers M, Kelly WG, et al: Hypotensive agents and pressor substances: Effect on the secretory role of aldosterone in man. JAMA 1960;174:234-240.Crossref 2. Genest J, Biron P, Koiw E, et al: Adrenocortical hormones in human hypertension and their relation to angiotensin. Circ Res 1961;9:775-791.Crossref 3. Ulick S, Gautier E, Vetter KK, et al: An aldosterone biosynthetic defect in a salt-losing disorder. J Clin Endocrinol Metabol 1964;24:669-672.Crossref 4. Biglieri EG, Slaton PE, Silen WS, et al: Postoperative studies of adrenal function in primary aldosteronism. J Clin Endocrinol Metabol 1966;26:553-558.Crossref 5. Laragh JH, Stoerk HC: On the mechanism of the sodium-retaining hormone (aldosterone). J Clin Invest 1957;36:383-392.Crossref 6. Zipser RD, Davenport MW, Martin KL, et al: Hyperreninemic hypoaldosteronism in the critically ill: A new entity. J Clin Endocrinol Metabol 1981;53:867-873.Crossref 7. Ito T, Woo J, Haning R, et al: A radioimmunoassay for aldosterone in human peripheral plasma including a comparison of alternate techniques. J Clin Endocrinol Metabol 1972;34:106-112.Crossref 8. Haber E, Koerner T, Page L: Application of a radioimmunoassay for angiotensin I to the physiologic measurements of plasma renin activity in normal subjects. J Clin Endocrinol Metabol 1969;29:1349-1355.Crossref 9. Kao M, Viona S, Nichols A, et al: Parallel radioimmunoassay for plasma cortisol and 11-deoxycortisol. Clin Chem 1975;21:1644-1647. 10. Liddle GW, Duncan Jr LE, Bartter FC: Dual mechanism regulating adrenocortical function in man. Am J Med 1956;21:380-386.Crossref 11. Matsuoka H, Mulrow PJ, Franco-Saenz R, et al: Effect of B-lipotropin and B-lipotropin derived peptides on aldosterone production in the rat adrenal gland. J Clin Invest 1981;68:752-759.Crossref 12. Carey RM, Thorner MO, Ortt EM: Effect of metoclopramide and bromocriptine on the renin-angiotensin-aldosterone system in man. J Clin Invest 1979;63:727-735.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Apr 1, 1983

References