Increase and uncoupling of adrenomedullin from the natriuretic peptide system in aneurysmal subarachnoid hemorrhage.
OBJECTIVE
Natriuresis is a common systemic manifestation of aneurysmal subarachnoid hemorrhage (SAH). Natriuresis and its accompanying hypovolemia may be a major contributing factor in the pathophysiology of symptomatic cerebral vasospasm.


METHODS
The authors studied 14 consecutive patients with aneurysmal SAH and compared levels of adrenomedullin (ADM), a novel endogenous natriuretic peptide that possesses additional profound vasodilatory properties, with the natriuretic peptide system by using radioimmunoassay. The mean ADM values on admission were 24.8 pg/ml, a twofold increase over control values, but no correlation was found with atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), and C-natriuretic peptide (CNP) from the natriuretic peptide system. At Day 5 post-SAH, ADM levels were significantly elevated in patients with vasospasm documented angiographically or on transcranial Doppler studies as compared with those who suffered no vasospasm (mean 61.9 pg/ml compared with 15.3 pg/ml, p < 0.01).


CONCLUSIONS
The authors conclude that an elevation of ADM in plasma may indicate a physiological regulatory attempt to induce cerebral vasodilation. The regulation of ADM is uncoupled from ANP, BNP, and CNP.
Wijdicks
E F
EF
Department of Neurology, Saint Marys Hospital, Rochester, Minnesota, USA. wijde@mayo.edu
Heublein
D M
DM
Burnett
J C
JC
D053607:Adrenomedullin; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000097:blood* / Q000175:diagnosis / Q000601:surgery; D008297:Male; D008875:Middle Aged; D045283:Natriuretic Agents / Q000097:blood*; D010455:Peptides / Q000097:blood*; D012016:Reference Values; D013345:Subarachnoid Hemorrhage / Q000097:blood* / Q000175:diagnosis / Q000601:surgery; D014664:Vasodilation / Q000502:physiology; D020301:Vasospasm, Intracranial / Q000097:blood* / Q000175:diagnosis / Q000601:surgery
D045283:Natriuretic Agents; D010455:Peptides; D053607:Adrenomedullin