Control of mineralocorticoid substitution in Addison's disease by plasma renin measurement
Abstract
In 7 out-patients with Addison's disease, plasma renin activity (PRA), plasma concentrations of angiotensin II (AT II), renin substrate (PRS), potassium, sodium and total protein, hematocrit, blood pressure, heart rate and body weight were studied after 2 weeks each on 2 mg of dexamethasone, 25 mg hydrocortisone (HC), 25 mg HC + 0.05 mg 9-alpha-fluorohydrocortisone (FC), 25 mg HC + 0.1 mg FC and 25 mg HC + 0.2 MG FC. Four further patients were less extensively studied. Mean PRA (upper normal limit, ambulatory: 12 ng AT I-ml-1-h-1) after the 5 steps of incremental substitution, starting with dexamethasone, was 192, 59, 38, 24 and 9 ng AT I-ml-1-h-1 rsp. PRS did not change with increasing substitution. PRA and AT II were significantly correlated (r = 0.91; p less than 0.0001) and proved to be the most sensitive parameters of insufficient mineralocorticoid substitution. With decreasing significance, PRA also correlated with plasma protein concentration, plasma sodium concentration (negative), delta body weight (negative), heart rate, delta mean blood pressure (negative) and plasma potassium concentration. PRA or AT II measurements are useful clinical tools to control mineralocorticoid substitution in Addisonian patients. Inappropriately high substitution can be prevented by keeping PRA in the upper normal range.
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Plasma renin activity in the upper reference range is a useful marker for a correct mineralocorticoid dose.
“Furthermore, plasma renin activity in the upper reference range has been found to be a useful marker for a correct mineralocorticoid dose (38,107,108).”
From Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline (2016) · cites this paper as [107]
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- Authors
- Oelkers, W., & L'age, M.
- Affiliations
- Freie Universität Berlin (DE)
- Venue
- Klinische Wochenschrift
- Published
- 1976-07
- Volume
- 54
- Issue
- 13
- Pages
- 607-612
- ISSN
- 0946-2716 (ISSN-L)
- 0023-2173
- 1432-1440
- OpenAlex
- W91700561
- Cited by
- 34
- References
- 19
- Citations by year
- 2026: 2 · 2023: 2 · 2021: 1 · 2018: 1 · 2017: 1 · 2016: 1 · 2015: 1 · 2014: 6
- FWCI
- 1.72
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of Molecular Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal Regulation and Hypertension
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Renin-Angiotensin System Studies
- Keywords
- Addison's disease, plasma renin activity, angiotensin II, renin substrate, cortisol, 9-alpha-fluorohydrocortisone, dexamethasone, blood pressure, plasma sodium, plasma potassium
- MeSH terms
- Addison Disease, Angiotensin II, Angiotensinogen, Dexamethasone, Drug Administration Schedule, Fludrocortisone, Humans, Hydrocortisone, Mineralocorticoids, Renin
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