Simplified screening procedures for primary aldosteronism. Studies on the mechanism of the hyper-responsiveness to furosemide and standing.
Screening tests for primary aldosteronism were compared in 22 patients with this disorder and 140 hypertensive controls. Adequate (93-100%) sensitivity and specificity were not provided by single tests ((1) serum K, (2) furosemide-stimulated PRA, or (3) plasma aldosterone concentration (PAC) after furosemide, or (4) after 2 liters 0.9% NaCl)), but were provided by combinations: (2) + (1) or (3); (2) + (1) or (4); and by a pressor response to saralasin + (3) or (4). Mechanism of the observed excessive rise in PAC "stimulated" by furosemide and standing for 2 h was studied in the same patients. The rise in "stimulated" PAC was (a) associated with a low PRA and not reproducible by angiotensin II infusions; (b) associated with a slight but significant rise in plasma cortisol and was reproducible by ACTH infusions. It is, therefore, attributed to the effects of slight ACTH release acting on adrenal tissue with super-sensitivity of aldosterone response to ACTH.
D000450:Aldosterone / Q000097:blood; D001794:Blood Pressure / Q000187:drug effects; D005665:Furosemide; D006801:Humans; D006929:Hyperaldosteronism / Q000175:diagnosis* / Q000503:physiopathology; D006973:Hypertension / Q000503:physiopathology; D008403:Mass Screening; D011187:Posture; D011188:Potassium / Q000097:blood; D012083:Renin / Q000097:blood; D012504:Saralasin
D000450:Aldosterone; D005665:Furosemide; D012083:Renin; D012504:Saralasin; D011188:Potassium