Adrenal Function After Prolonged Corticosteroid Therapy

Robinson, Brian H.; Mattingly, D; Cope, C. L.

doi:10.1136/bmj.1.5292.1579

Cited by 58 publications

(25 citation statements)

References 17 publications

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“…But further work does not support the conclusion that the aldosterone secretion or plasma level is raised in essential hypertension. Both we (Cope et al, 1962) and the main American workers (Laragh et al, 1960b) agree that in uncomplicated essential hypertension aldosterone secretion remains entirely within the normal range. In our series the mean value for subjects with essential hypertension was 130 jug.…”

Section: Hypertensionsupporting

confidence: 85%

“…in hypertensives with primary renal disease, the highest figures being in the most severely ill. Laragh et al (1960b) found well-increased aldosterone secretion rates in nearly all (93%) their patients with malignant hypertension. We (Cope et al, 1962) have found high aldosterone secretion in half of a small group of malignant hypertensives. The proportionate differences in frequency need not worry us unduly: they are readily explained by the type of clinical material.…”

Section: Changed Pattern In Other Types Of Hypertensionmentioning

confidence: 66%

“…Comparing ill normotensive subjects with hypertensives, Cope et al (1962) found the scatter of aldosterone secretion rates was equally wide, and the mean for the two groups was not significantly different.…”

Section: Changed Pattern In Other Types Of Hypertensionmentioning

confidence: 88%

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The adrenal cortex in internal medicine. II.

Cope¹

1966

BMJ

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_., 1966, 2, 914-921 Aldosterone The same interval elapsed between discovery of aldosterone In 1952 by Tait et al. and recognition of the first aldosteroneproducing tumour by Conn in 1954, as between recognition of adrenaline and the first adrenaline-producing tumour. If the rate of clinical progress has not changed in 45 years, that of technical progress has been immensely greater, making possible the isolation of aldosterone from human urine, its crystallization, and the determination and proof by synthesis of its chemical structure, all within two to three years. Shortly afterwards isotope-labelled samples of the hormone were prepared, and with this the daily secretion rate was first estimated. This rapid progress was all the more remarkable because the daily production is only about one-hundredth of that of cortisol.More recently plasma-aldosterone levels have been estimated, though the technique is exacting and the use of isotopes is essential: they average only about a thousandth of the normal plasma cortisol, or about a five-millionth of the normal plasmaglucose content. The now familiar estimations of similar low concentrations of vitamin B1 are made possible by the peculiar sensitivity of a living organism, but there is no equivalent specific organism or chemical reaction for aldosterone. Analysis still involves laborious separation by orthodox chromatographic methods, with assay by modern double isotope-derivative techniques, because the quantities are much too small even for classical microchemical methods. But in spite of the difficulties the general dynamics of aldosterone within the body have now been fairly completely worked out.Aldosterone is secreted into the systemic blood by the zona glomerulosa of the adrenal cortex at a rate which averages 130 ,ug. a day, but varies from 50 to 200 FLg. in normal circumstances. Circulating aldosterone, unlike cortisol, is only mildly bound to plasma protein, the mean being 65 % compared with 95% for cortisol (Daughaday et al., 1961). When blood passes through the liver its aldosterone is almost completely removed. The liver is probably the only major site of aldosterone destruction, for indirect isotopic estimates of the amount of blood cleared of aldosterone per minute coincide very closely with the estimated total liver blood-flow (Bougas et al., 1964). This volume of blood has been called the metabolic clearance rate for aldosterone. The rate of removal from the circulation is such that half the blood content is destroyed in about 30 minutes, and under normal circumstances this will be replaced by freshly secreted aldosterone. The plasma concentration at any time reflects the balance between secretion and destruction, the two being in approximate equilibrium. If any two of these three variables can be measured the third can be calculated.Estimates of total plasma aldosterone obtained either indirectly or directly, by the double isotope-derivative method,give a mean of 0.007 jug./100 ml. . Some of this minute amount leaks into the urine ; the renal clea...

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Section: Hypertensionsupporting

confidence: 85%

Section: Changed Pattern In Other Types Of Hypertensionmentioning

confidence: 66%

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The adrenal cortex in internal medicine. II.

Cope¹

1966

BMJ

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“…Altogether thcre was no difference Introduction Corticosteroids are an established treatment for asthma, and doses up to 7 mg of prednisolone may be sufficient to keep patients symptom-free. Even after prolonged use the risk of pituitary-adrenal axis suppression is minimal (Robinson et al, 1962). When taken by mouth, however, they act systemically and patients are exposed to the many and sometimes fatal effects of corticosteroids (Nielsen et al, 1963).…”

Section: Discussionmentioning

confidence: 99%

“…From the plasma cortisol levels obtained during the placebo period it can be concluded that there is no long-term suppression of the pituitary-adrenal axis. It may take up to 48 hours, however, for the actual recovery (Robinson et al, 1962), thus apart from complications like osteoporosis, bleeding from peptic ulcer, etc. inherent in oral steroid therapy, the obvious disadvantage of adrenal suppression during the period of therapy is eliminated by the use of beclomethasone dipropionate aerosol at the dosage used in this trial (300 Fg/day).…”

Section: Discussionmentioning

confidence: 99%

Comparison of Beclomethasone Dipropionate Aerosol and Prednisolone in Reversible Airways Obstruction

Lal¹,

Harris²,

Bhalla³

et al. 1972

BMJ

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in the patient's preference of the two treatment groups or in the number of times they used their bronchodilator aerosol, or in the forced expiratory volume in one second, vital capacity, or peak expfratory flow rate in the two treatment groups. The plasma cortisol levels when the patients were on the aerosol were much higher than when they were on prednisolone. The use of inhaled aerosol steroids seems to be preferable as it eliminates the usual complications of oral steroid therapy.

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Anti-Inflammatory Steroids: Mode of Action in Rheumatoid Arthritis and Homograft Reaction

Jasani¹

1979

Handbook of Experimental Pharmacology

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Adrenal Function After Prolonged Corticosteroid Therapy

Cited by 58 publications

References 17 publications

The adrenal cortex in internal medicine. II.

The adrenal cortex in internal medicine. II.

Comparison of Beclomethasone Dipropionate Aerosol and Prednisolone in Reversible Airways Obstruction

Anti-Inflammatory Steroids: Mode of Action in Rheumatoid Arthritis and Homograft Reaction

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