ACTH-Induced Sodium Retention in Pregnancy. Role of Desoxycorticosterone and Corticosterone*†

Abstract

Continued administration of ACTH to normal gravidas results in marked sodium retention that is sustained, while aldosterone excretion declines below pretreatment levels. Since this is similar to results noted in nonpregnant subjects, where the cumulative sodium retention has been ascribed to increments in ACTH-dependent mineralocorticoids such as desoxycorticosterone (DOC) and corticosterone (B), a study was designed to evaluate effects of administered ACTH in pregnancy upon the urinary excretion of DOC and B metabolites, tetrahydro-DOC (THDOC) and tetrahydro-B (THB).Control values for urinary THDOC excretion in pregnant women were markedly elevated; THB was within or just slightly above the normal nonpregnant range. Urinary THDOC and THB excretion increased more than twofold during ACTH administration while aldosterone excretion was depressed. Thus, the marked sodium retention induced by ACTH in pregnant women may be related to increments in secretion of DOC and B, as in nongravidas. Furthermore, the finding of increased urinary THDOC excretion as well as observations by others of marked increments in plasma DOC concentrations indicate that DOC secretion is substantially elevated in normal pregnancy. (J Clin Endocrinol Metab 38: 701, 1974) A DMINISTRATION of ACTH to normal A third trimester gravidas is accompanied by striking sodium retention (1). Of interest is that during prolonged ACTH administration, aldosterone excretion increases transiently but then declines below pretreatment values while sodium retention persists. This is similar to results noted is nonpregnant subjects where the sodium retention that continues after aldosterone excretion declines has been ascribed to increments in ACTH-dependent mineralocorticoids, such as desoxycorticosterone (DOC) and corticosterone (B) (2). The present study was designed to evaluate the effects of administered ACTH in pregnancy upon the urinary excretion of DOC and B metabolites, tetrahydro-DOC (THDOC) and tetrahydro-B (THB) and to correlate these with alterations in electrolyte balance, the excretion of aldosterone and cortisol, and changes in serum renin activity.

Recurrent Secretion of Progesterone in Large Amounts: An Endocrine/Metabolic Disorder Unique to Young Women?*

“…Plasma progesterone: The plasma levels of DOC, a potent mineralocorticosteroid, in near-term pregnant women (500-3,500 pg/ml) and their fetuses (1,500-6,000 pg/ml) (316-324) are 20-100 times those in men and nonpregnant women during the follicular phase of the cycle (25-50 pg/ml) (325). Furthermore, the plasma levels of DOC are not reduced in pregnant or midluteal phase nonpregnant women by the administration of dexamethasone (to inhibit ACTH), and DOC levels in plasma are not increased by the administration of ACTH to these women (317)(318)(319)(320)(321)(322)(323)327). Furthermore, the plasma levels of DOC are not reduced in pregnant or midluteal phase nonpregnant women by the administration of dexamethasone (to inhibit ACTH), and DOC levels in plasma are not increased by the administration of ACTH to these women (317)(318)(319)(320)(321)(322)(323)327).…”

Conversion of plasma progesterone to deoxycorticosterone in men, nonpregnant and pregnant women, and adrenalectomized subjects.

“…Importantly, it was also found that treatment of nearterm pregnant women with dexamethasone or ACTH did not lead to significant changes in plasma DOC concentrations (2,4,5,7,12). However in pregnant women near term, urinary 3a,21-dihydroxy-5,8-pregnan-20-one (tetrahydro-DOC) excretion was increased by ACTH-treatment (12). Nolten et al (7) concluded that these results could be explained as follows: ACTH-treatment of pregnant women was associated with an increase in plasma cortisol concentration.…”

“…Their view was based on the findings that the levels of DOC and DOC-sulfate in umbilical cord plasma were higher than those in maternal plasma (2,6,10,11) and that within 16-24 h after delivery, maternal plasma levels of DOC fell to levels found in nonpregnant women and men (2,6). Importantly, it was also found that treatment of nearterm pregnant women with dexamethasone or ACTH did not lead to significant changes in plasma DOC concentrations (2,4,5,7,12). However in pregnant women near term, urinary 3a,21-dihydroxy-5,8-pregnan-20-one (tetrahydro-DOC) excretion was increased by ACTH-treatment (12).…”

Physiological Concentrations of Growth Hormone Exert Insulin-Like and Insulin Antagonistic Effects on Both Hepatic and Extrahepatic Tissues in Man*

“…However, Winkel et al (7,8) noted that in all of these situations there were parallel increases in Prog secretion by the adrenal cortex and ovary. However, DOC in pregnant women was not stimulated or suppressed by ACTH, angiotensin, or dexamethasone (3,5,22,(25)(26)(27). However, DOC in pregnant women was not stimulated or suppressed by ACTH, angiotensin, or dexamethasone (3,5,22,(25)(26)(27).…”