Exchangeable Sodium and Aldosterone Secretion in Children with Congenital Adrenal Hyperplasia due to 21-Hydroxylase Deficiency

Loras, B; Haour, F.; Bertrand, Jessica

doi:10.1203/00006450-197003000-00005

Cited by 9 publications

(9 citation statements)

References 12 publications

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“…PRA decreases progressively over weeks and months (8, 16,22); a similar trend is followed by aldosterone secretion rates (4), plasma aldosterone (4), and exchangeable sodium (19).…”

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confidence: 87%

Plasma Renin Activity Related to Sodium Balance, Renal Function and Urinary Vasopressin in the Newborn Infant

Godard

Geering

et al. 1979

Pediatr Res

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Summary MATERIALS AND METHODSPlasma renin activity was determined in 25 healthy, full-term, newborn infants aged 1 day to 9 weeks. High values were found, the mean level at 1-2 days of life (24.8 +. 8.4 ng/ml/hr, SE) being significantly higher than the mean levels at 7-9 days (5.8 + 1.5) and at 4-9 weeks (8.1 f 13) (P < 0.05). No correlation was found between plasma renin activity and systolic blood pressure, hematocrit, creatinine clearance, serum sodium, or serum potassium. Plasma renin activity (log values) was inversely correlated with sodium intake (r = -0.58) or with urinary sodium ( r = -OM), and positively with urinary osmolality (r = 0.67). The correlations reached higher coefFicients if only infants aged 5 9 days were considered.In addition, vasopressin was measured by radioimmunoassay in the urine. The daily excretion was lower in newborn infants (9.4 f 1.6 ng/m2/day, SE, at 1-2 days of postnatal life) than in healthy children (37.1 + 5.6), and was significantly correlated with creatinine clearance ( r = 0.69), but not with urinary osmolality. SpeculationThe postnatal changes of plasma renin activity were significantly correlated only with parameters of sodium balance and with urinary osmolality, so that one can speculate that early after birth, the renin-angiotensin system plays a preponderant role not only in sodium homeostasis, but also in water balance.Plasma renin activity (PRA) (8,16,23,27) and angiotensin I1 concentration (7) are relatively high in human newborn infants. PRA decreases progressively over weeks and months (8,16,22); a similar trend is followed by aldosterone secretion rates (4), plasma aldosterone (4), and exchangeable sodium (19).The cause of increased activity of the renin-angiotensin system during the neonatal period is not clear. The low sodium intake, the low blood pressure, the hypovolemia, and the increased sympathetic activity ,have been invoked as possible factors. On the other 'hand, no correlation was found between PRA and plasma aldosterone. either in cord blood (10, 26) or in newborn infants . . , aged 2-3 days (26), suggesting that angiotensin I1 is not a predominant regulatory factor controlling aldosterone secretion at this age.In an effort to gain insight into the interplay between renin, sodium, and renal function during the neonatal period, we have studied the relationship between PRA, sodium intake and output, urine osmolality, and glomerular filtration rate (GFR) in hea6hy, full-term newborns of different ~ostnatal aees. In addition. vaso-" pressin was determined in the urine, because limited data are available concerning this hormone in human newborns. 7

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“…PRA decreases progressively over weeks and months (8, 16,22); a similar trend is followed by aldosterone secretion rates (4), plasma aldosterone (4), and exchangeable sodium (19).…”

mentioning

confidence: 87%

Plasma Renin Activity Related to Sodium Balance, Renal Function and Urinary Vasopressin in the Newborn Infant

Godard

Geering

et al. 1979

Pediatr Res

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“…It has been previously established that low aldosterone secretion rates (2)(3)(4)6,7) or plasma levels (18) were found in the salt-losing form of congenital adrenal hyperplasia. These determinations had mainly been performed in infants and prepubertal children under various states of steroid replacement therapy.…”

Section: Discussionmentioning

confidence: 99%

“…Intramuscular deoxycorticosterone-trimethylacetate (DOC-TMA) treatment had been discontinued from 3 years to 15 years before this study in 6 salt-losers (Cases No. 1,2,4,6,7,11). The 5 other children (cases No.…”

Section: Methodsmentioning

confidence: 98%

“…These data indicate that: 1) there is an increased secretion of aldosterone suggesting an increase in adrenal activity close to or during puberty in salt-losers which parallels that of non salt-losers, 2) this increased PA could play a role in the apparent remission of salt-loss in patients off mineralocortdcoid treatment, but it is not capable of preventing saltlosing crises as reflected by the impaired post-ACTH PA response, and 3) blunted PA and 17-OH P responses to ACTH were observed during 9a-FF administration. (J Clin Endocrinol Metob 45: 551, 1977) L OW ALDOSTERONE secretion or excretion rates have generally been observed in infants and children with the saltlosing form of congenital adrenal hyperplasia due to 21-OH-deficiency (2)(3)(4)(5)(6)(7). Past studies have not, however, included adolescents and adults, the assumption being that low aldosterone secretion persisted whatever the age of the patient (7).…”

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confidence: 95%

“…(J Clin Endocrinol Metob 45: 551, 1977) L OW ALDOSTERONE secretion or excretion rates have generally been observed in infants and children with the saltlosing form of congenital adrenal hyperplasia due to 21-OH-deficiency (2)(3)(4)(5)(6)(7). Past studies have not, however, included adolescents and adults, the assumption being that low aldosterone secretion persisted whatever the age of the patient (7). In apparent support of this assumption, severe salt-losing crises have been observed in this clinic among several prepubertal children and adolescents receiving no mineralocorticoid treatment.…”

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confidence: 99%

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Plasma Aldosterone, Renin Activity, and 17α-Hydroyprogesterone in Salt-Losing Congential Adrenal Hyperplasia. I. Response to ACTH in Hydrocortisone Treated Patients and Effect of 9α-Fluorotisol

Limal

Rappaport

Bayard

1977

The Journal of Clinical Endocrinology & Metabolism

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Plasma aldosterone (PA), renin activity (PRA), and 17-OH-progesterone (17-OH P) were measured in a group of 11 salt-losers with congenital adrenal hyperplasia (21-OH-deficiency) aged 5-20 years, treated with oral hydrocortisone and under a constant sodium diet. A group of 7 non salt-losers and 10 normal children were evaluated for comparison. Salt-losers had mean baseline concentrations of PA, PRA, and 17-OH P that were significantly higher (P < 0.02, P < 0.05, and P < 0.001, respectively) than in normal controls, but comparable to non salt-loser levels. In salt-losers, a positive correlation (P = 0.01) was found when PA was plotted against chronological age. ACTH was unable to raise PA in salt-losers, but there was a normal rise in non salt-losers.The addition of 9a-fluorocortisol (9a-FF) (100 figf 24 h for 7-13 months) succeeded in lowering mean PA and PRA to normal levels in 8 salt-losing patients. The same was observed in 4 non salt-losers, with, in addition, a blunted PA response to ACTH. In the two patient groups, the mean basal 17-OH P value was lowered and a similar decreased response to ACTH was observed. These data indicate that: 1) there is an increased secretion of aldosterone suggesting an increase in adrenal activity close to or during puberty in salt-losers which parallels that of non salt-losers, 2) this increased PA could play a role in the apparent remission of salt-loss in patients off mineralocortdcoid treatment, but it is not capable of preventing saltlosing crises as reflected by the impaired post-ACTH PA response, and 3) blunted PA and 17-OH P responses to ACTH were observed during 9a-FF administration. (J Clin Endocrinol Metob 45: 551, 1977)

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Congenital Adrenal Hyperplasia

New

Levine

1984

Monographs on Endocrinology

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This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically those of translation, reprinting, fe-use of illustrations, broadcasting, reproduction by photocopying machine or similar means, and storage in data banks. Under §54 of the German Copyright Law where copies are made for other than private use. a fee is payable to 'Verwertungsgesellschaft Wort'. Munich. 1[. Springer-Verlag Berlin. Heidelberg 1984 Softcover reprint of the hardcover 1 st edition 1984The use of registered names, trademarks, etc. in this publication does not imply. even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use.Product Liability: The publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check its accuracy by consulting other pharmaceutical literature.

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Exchangeable Sodium and Aldosterone Secretion in Children with Congenital Adrenal Hyperplasia due to 21-Hydroxylase Deficiency

Cited by 9 publications

References 12 publications

Plasma Renin Activity Related to Sodium Balance, Renal Function and Urinary Vasopressin in the Newborn Infant

Plasma Renin Activity Related to Sodium Balance, Renal Function and Urinary Vasopressin in the Newborn Infant

Plasma Aldosterone, Renin Activity, and 17α-Hydroyprogesterone in Salt-Losing Congential Adrenal Hyperplasia. I. Response to ACTH in Hydrocortisone Treated Patients and Effect of 9α-Fluorotisol

Congenital Adrenal Hyperplasia

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