Maternal pseudo primary hyperaldosteronism in twin-to-twin transfusion syndrome.
OBJECTIVE
To monitor changes in the maternal renin-angiotensin-aldosterone system following laser therapy and amnioreduction in severe twin-to-twin transfusion syndrome (TTTS).


METHODS
Observational prospective study.


METHODS
Single university hospital in Poissy, France.


METHODS
Sixty cases of TTTS at 16-26 weeks of gestation.


METHODS
Maternal blood sampling before, 6 and 24 hours following the procedure.


METHODS
Plasma levels of aldosterone, renin, angiotensin II (AII), atrial natriuretic peptide (ANP), vasopressin, sodium, potassium and plasma proteins together with full blood count were measured before, 6 and 24 hours following the procedure.


RESULTS
TTTS is associated with maternal hyperaldosteronism dissociated from renin-angiotensin changes. Correcting TTTS by placental surgery and amnioreduction triggers incomplete correction of hyperaldosteronism, as early as 6 hours following the procedure, without changes in AII but an increase in the levels of ANP in plasma. Electrolyte concentrations remained stable despite haemodilution, while vasoactive hormone levels such as that of vasopressin remained unchanged.


CONCLUSIONS
Mechanisms involved in marked fluid retention in TTTS are rapidly corrected by laser therapy followed by amnioreduction while maintaining electrolyte homeostasis.
Gussi
I L
IL
Department of Obstetrics and Gynecology, CHI Poissy Saint Germain, Université de Versailles Saint-Quentin-en-Yvelines, Poissy, France.
Nizard
J
J
Yamamoto
M
M
Robyr
R
R
Ville
Y
Y
D000328:Adult; D000704:Analysis of Variance; D009320:Atrial Natriuretic Factor / Q000097:blood; D005260:Female; D005330:Fetofetal Transfusion / Q000628:therapy*; D006400:Hematocrit; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D006929:Hyperaldosteronism / Q000150:complications*; D053685:Laser Therapy / Q000379:methods; D010952:Plasma Substitutes; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy*; D018607:Pregnancy Reduction, Multifetal / Q000379:methods*; D011262:Pregnancy Trimester, Second; D011272:Pregnancy, Multiple; D012083:Renin / Q000097:blood; D014667:Vasopressins / Q000097:blood
D006454:Hemoglobins; D010952:Plasma Substitutes; D014667:Vasopressins; D009320:Atrial Natriuretic Factor; D012083:Renin