saralasin and Hyperaldosteronism

Topics: Adenoma; Adrenal Gland Neoplasms; Adrenocortical Hyperfunction; Catecholamines; Contraceptives, Oral, Hormonal; Estrogens; Female; Humans; Hyperaldosteronism; Hypertension; Hypertension, Renal; Hypertension, Renovascular; Male; Pheochromocytoma; Renin; Saralasin; Sodium

Topics: Adrenergic beta-Antagonists; Angiotensin II; Blood Pressure; Diagnosis, Differential; Diuretics; Ferricyanides; Furosemide; Humans; Hyperaldosteronism; Hypertension; Hypertension, Renal; Nitroprusside; Oligopeptides; Pheochromocytoma; Propranolol; Renal Veins; Renin; Saralasin; Stimulation, Chemical; Teprotide

Topics: Aldosterone; Blood Volume; Female; Humans; Hyperaldosteronism; Hypertension; Hypertension, Malignant; Hypertension, Renal; Middle Aged; Propranolol; Renal Veins; Renin; Saralasin; Sodium; Teprotide; Vasoconstriction

Topics: Adrenal Cortex Hormones; Adrenal Gland Neoplasms; Adrenocorticotropic Hormone; Aldosterone; Catecholamines; Cushing Syndrome; Diagnosis, Differential; Humans; Hyperaldosteronism; Hypertension; Pheochromocytoma; Renin; Saralasin

Topics: Angiotensin II; Arginine Vasopressin; Blood Pressure; Calcium; Captopril; Cold Temperature; Enzyme Precursors; Humans; Hyperaldosteronism; Hypertension; Hypertension, Malignant; Hypertension, Renal; Magnesium; Natriuretic Agents; Propranolol; Renin; Renin-Angiotensin System; Saralasin; Sodium; Teprotide

Topics: 1-Sarcosine-8-Isoleucine Angiotensin II; Adult; Aldosterone; Angiotensin II; Blood Pressure; Heart Rate; Humans; Hyperaldosteronism; Hypertension; Hypertension, Renovascular; Middle Aged; Renin; Saralasin

We evaluated a new method utilizing saralasin to differentiate primary aldosteronism due to an aldosterone-producing adenoma from idiopathic hyperaldosteronism. The test is based on the marked difference in sensitivity to angiotensin II of aldosterone-producing adenomas and hyperplastic adrenal glands and the partial angiotensin II agonist property of saralasin in low-renin states. Saralasin was infused into 14 patients with primary aldosteronism and the plasma aldosterone responses determined. Plasma aldosterone concentration increased in all eight patients with idiopathic hyperaldosteronism, whereas there was no increase in plasma aldosterone in six patients who had a solitary adenoma. We concluded that saralasin may be a clinically useful, noninvasive tool to distinguish patients with an aldosterone-producing adenoma from those who have idiopathic hyperaldosteronism.

Topics: Adenoma; Adrenal Gland Neoplasms; Adult; Aldosterone; Blood Pressure; Diagnosis, Differential; Female; Humans; Hydrocortisone; Hyperaldosteronism; Male; Middle Aged; Saralasin

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.

Topics: Aldosterone; Blood Pressure; Furosemide; Humans; Hyperaldosteronism; Hypertension; Mass Screening; Posture; Potassium; Renin; Saralasin

To study the secretion of adrenocortical steroids, the renin releasing test and the angiotensin II analog (1-Sar, 8-Ala-Angiotensin II) infusion test was performed on four subjects with primary aldosteronism. The plasma renin activities of these subjects in the preoperative state were rather low, without any response to the renin releasing test. Plasma aldosterone was, however, significantly high and showed a tendency to declineits value when the subject was in an upright position. In the preoperative state, all the subjects lacked any alterations in plasma renin activity throughout the angiotensin II analog infusion test. Though slight elevations were observed in the blood pressure of three subjects, there was no demonstrable change in plasma aldosterone. In the other subject, though blood pressure did not change, plasma aldosterone exhibited a remarkable rise as did progesterone, 11-deoxycorticosterone and corticosterone. From these data, it was suggested that in the latter subject the aldosterone secretion was sensitive to angiotensin in comparison with ACTH. Three weeks after the operation, it was observed that plasma aldosterone response decreased, while the response of plasma renin activity to the renin releasing test was normal. This is considered to be due to the diminished sensitivity of the glomerulosa of the nonadenomatous adrenal gland to angiotensin. The levels of 17 alpha-hydroxyprogesterone, 11-deoxycorticosterone and corticosterone were almost within the normal range in the pre- and postoperative state. The levels of plasma progesterone and 11-deoxycorticosterone, however, tended to be lower in the postoperative state compared with the preoperative state.

Topics: Adrenal Cortex Hormones; Adult; Aldosterone; Angiotensin II; Corticosterone; Female; Humans; Hydrocortisone; Hydroxyprogesterones; Hyperaldosteronism; Male; Middle Aged; Progesterone; Renin; Saralasin

Two siblings are described with hypertension, hyperreninism, hyperaldosteronism and hypokalemia. Propranolol therapy lowered blood pressure markedly, but failed to normalize serum potassium. Indomethacin orally decreased blood pressure and normalized all biochemical abnormalities. We suggest that in these patients there exists a renin-dependent hypertension in combination with a state of hyperprostaglandinism. It is likely from our studies in these 2 patients, that the state of hyperprostaglandinism is secondary to a hypertension with increased sympathetic tone.

Topics: Adolescent; Adult; Angiotensin II; Drug Therapy, Combination; Female; Humans; Hyperaldosteronism; Hypertension; Hypokalemia; Indomethacin; Male; Propranolol; Prostaglandins; Renin; Saralasin; Spironolactone; Syndrome

Three patients suffering from Bartter's syndrome were studied before and after 5 days of treatment with the prostaglandin synthetase inhibitors, aspirin and indomethacin. Saralasin was given by intravenous infusion in increasing doses from 0.6 to 42 micrograms/min.kg/BW. During saralasin infusion a blood pressure reduction was observed in all patients. Aspirin treatment did not affect this response and nor did it affect other manifestations of the syndrome. Indomethacin treatment changed the blood pressure response to saralasin in such a way that the blood pressure was increased in one patient and was unchanged in the other. Indomethacin also tended to normalize other features of Bartter's syndrome, such as the hyperreninaemia and angiotensin unresponsiveness, but did not affect the hypokalaemia. The saralsin effect on blood pressure is thus evidently inversely related to the prevailing activity of the renin-angiotensin system in this condition also, and the patients obviously depended on the renin-angiotensin system to maintain their blood pressure. Our findings, together with data in the literature, indicate that angiotensin unresponsiveness of the vascular bed is not a primary feature in Bartter's syndrome. Chloride loss is currently thought to be the basic abnormality and this may link the Bartter's syndrome with other diseased states characterized by chloride loss, such as the syndrome of habitual vomiting and chronic treatment with loop diuretics.

Topics: Adolescent; Adult; Angiotensin II; Aspirin; Bartter Syndrome; Blood Pressure; Cyclooxygenase Inhibitors; Electrolytes; Female; Humans; Hyperaldosteronism; Indomethacin; Male; Prostaglandins; Renin; Saralasin

Topics: Adenoma; Adrenal Gland Neoplasms; Adrenal Glands; Adult; Aldosterone; Desoxycorticosterone; Female; Fludrocortisone; Humans; Hyperaldosteronism; Hyperplasia; Male; Middle Aged; Posture; Potassium; Saralasin; Sodium; Sodium Chloride

Topics: Adult; Age Factors; Aldosterone; Amino Acid Sequence; Angiotensin II; Angiotensins; Female; Humans; Hyperaldosteronism; Hypertension; Hypertension, Renovascular; Kinetics; Male; Middle Aged; Renin; Saralasin; Sodium

Topics: Adenoma; Adrenal Cortex Neoplasms; Adrenal Gland Diseases; Adrenocorticotropic Hormone; Cushing Syndrome; Female; Humans; Hydrocortisone; Hyperaldosteronism; Hyperplasia; Hypertension; Hypokalemia; Hypothalamo-Hypophyseal System; Methods; Middle Aged; Saralasin

Infusion of the angiotensin-II-antagonist saralasine led in one patient with Bartter's syndrome and one patient with decompensated hepatic cirrhosis, both of whom had a markedly raised plasma renin activity, to a fall in systolic and diastolic blood pressure. The results indicate that in normotensive patients a raised angiotensin II concentration in blood is haemodynamically important for the level of blood pressure if plasma renin activity is raised. In normotensives with normal plasma renin activity saralasine in the usual dosage (4.2 mug/kg-min) does not influence the blood pressure.

Topics: Adult; Aldosterone; Angiotensin II; Bartter Syndrome; Blood Pressure; Diuresis; Female; Heart Rate; Humans; Hyperaldosteronism; Kidney; Liver Cirrhosis; Male; Middle Aged; Renin; Saralasin

To investigate the role of the renin angiotensin system in the pathogenesis of hypertension in Cushing's syndrome two patients with hypercorticism were infused with 20 mg saralasin (1-sar-8-ala-angiotensin II) over a period of 30 minutes under constant blood pressue control. In addition, one patient with primary aldosteronism, an established form of mineralocorticoid hypertension, served as control. Neither in the two patients with Cushing's syndrome nor in the patient with primary aldosteronism could a blood pressure lowering effect of saralasin be observed. In the two patients with hypercoritcism both renin activity and plasma aldosterone increased during saralasin infusion. The patient with primary aldosteronism only showed a weak increase in plasma aldosterone concentration.

Topics: Aldosterone; Angiotensin II; Blood Pressure; Cushing Syndrome; Female; Humans; Hyperaldosteronism; Hypertension; Renin; Saralasin

The angiotensin antagonist saralasin (1-sar-8-ala-angiotensin II) was given to 27 patients with different forms of secondary hypertension. The blood pressure fell in 6 of 7 patients with renal artery stenosis and in 4 of 10 patients with terminal renal failure on regular hemodialysis. No change or a rise in blood pressure was observed in 3 patients with Cushing's syndrome, 4 patients with primary aldosteronism, 3 patients with hypertension and a unilateral small kidney of other than renovascular origin, and 6 patients with terminal renal failure. It can be concluded from the results that angiotensin II is involved in the pathogenesis of renovascular hypertension and in some cases of hypertension accompanying chronic renal failure.

Topics: Angiotensin II; Cushing Syndrome; Humans; Hyperaldosteronism; Hypertension, Renal; Kidney Failure, Chronic; Renal Artery Obstruction; Saralasin

The effect of saralasin in lowering blood pressure and plasma aldosterone concentration in normal subjects, both sodium-replete and sodium-deplete, and in patients with various forms of hypertension, is closely related to the basal plasma angiotensin II concentration. These findings confirm and extend earlier studies of angiotensin II/arterial pressure and angiotensin II/aldosterone dose-response curves. They also emphasize the importance of the renin-angiotensin system in the control of aldosterone in sodium depletion and in renal hypertension.

Topics: Aldosterone; Angiotensin II; Blood Pressure; Diet; Humans; Hyperaldosteronism; Hypertension; Kidney Failure, Chronic; Male; Renal Artery Obstruction; Renin; Saralasin; Sodium; Time Factors

Topics: Angiotensin II; Blood Pressure; Blood Volume; Humans; Hyperaldosteronism; Hypertension; Renin; Saralasin; Sodium; Teprotide