title: Adrenocortical function in hypotensive patients with end stage renal disease.
abstract: BACKGROUND
  Sustained hypotension among patients with end stage renal disease on dialysis (ESRDh) varies from 5.0% to 12.0%. Despite their role in the regulation of blood pressure (BP) corticoadrenal hormones have been poorly investigated.
  
  
  OBJECTIVE
  This study aims to detect adrenal insufficiency in ESRDh and follow their clinical outcome.
  
  
  METHODS
  Fifty ESRDh and 30 healthy volunteers were studied. In all cases basal blood and saliva were obtained. Synthetic ACTH (25μg) was injected intramuscularly and at 30min saliva was collected. Circulating ACTH, renin, cortisol and aldosterone were measured and steroids were also assessed in saliva by immunoassay.
  
  
  RESULTS
  Fifteen ESRDh achieved steroid responses not different than healthy volunteers; four had primary adrenal insufficiency; six had secondary adrenal insufficiency; nine had selective hypoaldosteronism and sixteen secondary hyperaldosteronism. The years on dialysis did not differ among subgroups. ROC analysis defined the following cut-offs for basal cortisol to predict adrenal insufficiency: in serum ⩽232.0nM (sensitivity (S) 100.0% and specificity (E) 90.0%); in saliva ⩽4.4nM (100.0% S and E). Basal aldosterone cut-off values to predict hyperaldosteronism were: in serum >500.0pM and saliva >60.0pM (100.0% S and E, for both). For the prediction of hypoaldosteronism the basal serum aldosterone was ⩽260.0pM (100% S; 53% E) and in saliva it was ⩽20.1pM (100% S; 58.5% E). Three patients with primary adrenal insufficiency and six with secondary adrenal insufficiency improved general clinical condition and normalized BP on steroids. One patient died before initiation of steroid therapy.
  
  
  CONCLUSIONS
  Adrenal function should be assessed in ESRDh in order to unmask adrenal insufficient states.
authors.affiliation: Endocrine Research Department, Instituto de Investigaciones Médicas A.Lanari, University of Buenos Aires, Argentina. Electronic address: alaegger@yahoo.com.
authors.forename: Alejandro L
authors.initials: AL
authors.lastname: Arregger
authors.affiliation: Unidad Ejecutora Instituto de Investigaciones Médicas, Consejo Nacional de Investigaciones Científicas y Técnicas, Argentina; Laboratory of Salivary Glands, School of Dentistry, University of Buenos Aires, Argentina.
authors.forename: Estela M L
authors.initials: EM
authors.lastname: Cardoso
authors.affiliation: Chair Medical Education and Research Department, Instituto de Investigaciones Médicas A.Lanari, University of Buenos Aires, Argentina.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Zucchini
authors.affiliation: Department of Nephrology, Instituto de Investigaciones Médicas A.Lanari, University of Buenos Aires, Argentina.
authors.forename: Elvira C
authors.initials: EC
authors.lastname: Aguirre
authors.affiliation: Centro de estudios Renales e Hipertensión Arterial, Argentina.
authors.forename: Alicia
authors.initials: A
authors.lastname: Elbert
authors.affiliation: Endocrine Research Department, Instituto de Investigaciones Médicas A.Lanari, University of Buenos Aires, Argentina; Unidad Ejecutora Instituto de Investigaciones Médicas, Consejo Nacional de Investigaciones Científicas y Técnicas, Argentina; Laboratory of Salivary Glands, School of Dentistry, University of Buenos Aires, Argentina.
authors.forename: Liliana N
authors.initials: LN
authors.lastname: Contreras
mesh_terms: D000302:Adrenal Cortex / Q000503:physiopathology*; D000328:Adult; D000450:Aldosterone / Q000378:metabolism; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism; D007022:Hypotension / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D012463:Saliva / Q000378:metabolism
chemical_list: D000450:Aldosterone; D006854:Hydrocortisone
keywords: ACTH-stimulation test; Chronic renal failure; Salivary aldosterone; Salivary cortisol