Potassium regulation and progesterone‐aldosterone interrelationships in human pregnancy: A prospective study

Ma, Ben; Sinosich, MJ; Dm, Saunders; Gallery, Eileen D.M.

doi:10.1016/0020-7292(87)90282-7

Cited by 13 publications

(19 citation statements)

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“…Although epinephrine and dopamine increased when moving from LLD to upright position, the values were not significantly different comparing pregnancy to postpartum. Serum potassium levels were lower during pregnancy and did not differ between trimesters despite the increased Aldo being markedly greater in the third trimester, consistent with prior data (42). Consequently, serum potassium does not explain the dissociation.…”

Section: Discussionsupporting

confidence: 87%

The Renin-Aldosterone Response to Stimulation and Suppression During Normal Pregnancy

Bentley‐Lewis

Graves

Seely

2005

Hypertension in Pregnancy

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Objective-During normal pregnancy, studies have shown increased activity of the reninangiotensin-aldosterone system (RAAS) and a dissociation of plasma renin activity (PRA) and aldosterone (Aldo) evidenced by a greater increase in Aldo relative to PRA. The aims of this study were to examine the RAAS response to stimulation by upright posture and suppression by saline infusion and to investigate the PRA-Aldo dissociation under these two conditions. Methods-We studied 24 healthy normotensive women (mean ± standard error of mean, ages 29 ± 1 yrs) in sodium (Na) balance in the second and third trimesters and postpartum. Subjects underwent a 24-hour urine collection which was analyzed for Na, norepinephrine (NE), epinephrine (Epi), and dopamine (DA); a posture study with analysis of blood pressure (BP), PRA, Aldo, NE, Epi, DA, and cortisol; and a 0.9% NaCl infusion study (500 mL/hr for 3 hrs) with analysis of BP, PRA, Aldo, cortisol, and digitalis-like factor (DLF). Analyses included paired t tests to compare posture and saline responses, repeated measures to compare across periods, and percent change to evaluate the PRA-Aldo dissociation.Results-During pregnancy, PRA, Aldo, BP, catecholamines, and cortisol levels were significantly greater in upright than left lateral decubitus (LLD) posture, and the percent change in Aldo was significantly greater than the percent change in PRA. During pregnancy in response to saline infusion, BP did not change; the PRA and Aldo significantly decreased; the percent change in Aldo was significantly greater than the percent change in PRA in the second trimester; and serum DLF and cortisol levels significantly decreased.Conclusions-In longitudinally studied normal pregnancy, PRA and Aldo levels were dissociated at baseline, with stimulation and, to a lesser degree, with suppression. Norepinephrine, adrenocorticotrophic hormone, and DLF may contribute to this dissociation, and clarification of these interactions may provide insight into the regulation of aldosterone during normal and hypertensive pregnancy.

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Section: Discussionsupporting

confidence: 87%

The Renin-Aldosterone Response to Stimulation and Suppression During Normal Pregnancy

Bentley‐Lewis

Graves

Seely

2005

Hypertension in Pregnancy

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“…Women who have had either normal or only mildly elevated blood pressures during pregnancy may present with severe postpartum hypertension [38,41]. In such cases, the potassium level should be checked and, if low, a diagnosis of PAP should be considered.…”

Section: Primary Aldosteronismmentioning

confidence: 99%

“…Suppressed plasma renin activity (levels less than 0.6 ng/ml/h) with an elevated aldosterone-renin ratio has been used to diagnose hyperaldosteronism in the general population. In pregnancy, plasma renin activity is increased physiologically by as much as eightfold [38]. Based on published case series, and our clinical experience, pregnant women with primary aldosteronism demonstrate plasma renin activity (PRA) levels that are higher compared to levels observed in primary aldosteronism in non-pregnant individuals, but lower than either normotensive pregnant women or women with chronic essential hypertension in pregnancy [39,40].…”

Section: Primary Aldosteronismmentioning

confidence: 99%

“…Diagnosis of PA during pregnancy (PAP) is challenging due to the heterogeneity in clinical manifestations and the profound alterations in the renin angiotensin system in normal pregnancy [38]. Suppressed plasma renin activity (levels less than 0.6 ng/ml/h) with an elevated aldosterone-renin ratio has been used to diagnose hyperaldosteronism in the general population.…”

Section: Primary Aldosteronismmentioning

confidence: 99%

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Secondary Hypertension in Pregnancy

2015

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Hypertension is a common medical complication of pregnancy. Although 75-80 % of women with preexisting essential hypertension will have uncomplicated pregnancies, the presence of secondary forms of hypertension adds considerably to both maternal and fetal morbidity and mortality. Renovascular hypertension, pheochromocytoma, and Cushing's syndrome in particular are associated with accelerating hypertension, superimposed preeclampsia, preterm delivery, and fetal loss. Primary aldosteronism is a more heterogeneous disorder; there are well-documented cases where blood pressure and hypokalemia are improved during pregnancy due to elevated levels of progesterone. However, superimposed preeclampsia, worsening hypertension, and early delivery are also reported. When possible, secondary forms of hypertension should be diagnosed and treated prior to conception in order to avoid these complications.

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“…7 Renin production, a major regulator of aldosterone production, also increases during pregnancy, but the increment seems as an insufficient explanation of high circulating aldosterone levels, as the ratio of aldosterone/renin is substantially increased throughout gestation. 8,9 Similarly, aldosterone increases and the rise is greater than that of Ang II, as women move on from being nonpregnant, conceive, and progress to the third trimester. [10][11][12] Infusion of increasing Ang II doses to both pregnant and nonpregnant women similarly lead to increments in plasma aldosterone concentrations arguing against significant receptor-dependent changes in Ang II-sensitivity.…”

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confidence: 99%

Vascular Endothelial Growth Factor-A and Aldosterone

et al. 2013

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Abstract-Aldosterone levels are markedly elevated during normal pregnancy but fall even though volume contracts when preeclampsia occurs. The level of aldosterone in either condition cannot be explained solely by the activity of the renin-angiotensin II system. In normal gestation, vascular endothelial growth factor (VEGF) is thought to maintain vascular health, but its role in adrenal hormone production is unknown. We hypothesized that the role of VEGF in the adrenal gland is to maintain vascular health and regulate aldosterone production. Here, we demonstrate that supernatant of endothelial cells grown in the presence of VEGF enhanced aldosterone synthase activity in human adrenocortical cells. VEGF either alone or combined with angiotensin II increased aldosterone production in adrenal cells. These data suggest that endothelial cell-dependent and independent activation of aldosterone is regulated by VEGF. In contrast to angiotensin II, VEGF did not upregulate the steroidogenic acute regulatory protein. Consistent with this observation, angiotensin II stimulated both aldosterone and cortisol synthesis from progesterone, whereas VEGF stimulated selectively aldosterone production. In rats, overexpression of soluble fms-like tyrosine kinase-1, an endogenous VEGF inhibitor, led to adrenocortical capillary rarefaction and fall in aldosterone concentrations that correlated inversely with soluble fms-like tyrosine kinase-1 levels. These findings may explain why aldosterone increases so markedly during normal gestation and why preeclampsia, a condition characterized by high soluble fms-like tyrosine kinase-1, is associated with inappropriately low aldosterone levels in spite of relatively lower plasma volumes. (Hypertension. 2013;61:1111-1117.) • Online Data SupplementKey Words: adrenal cell ■ aldosterone ■ aldosterone synthase ■ preeclampsia ■ soluble fms-like tyrosine kinase-1 ■ steroidogenic acute regulatory protein ■ vascular endothelial growth factor

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Potassium regulation and progesterone‐aldosterone interrelationships in human pregnancy: A prospective study

Cited by 13 publications

References 0 publications

The Renin-Aldosterone Response to Stimulation and Suppression During Normal Pregnancy

The Renin-Aldosterone Response to Stimulation and Suppression During Normal Pregnancy

Secondary Hypertension in Pregnancy

Vascular Endothelial Growth Factor-A and Aldosterone

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