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Control of mineralocorticoid substitution in Addison's disease by plasma renin measurement

Kontrolle der Mineralocorticoid-Substitution bei Addisonscher Krankheit durch Bestimmung von Plasma-Renin

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Zusammenfassung

Bei 7 ambulanten Patienten mit Addisonscher Krankheit wurden die Plasma-Renin-Aktivität (PRA) und die Plasma-Konzentrationen von Angiotensin II (AT II), Renin-Substrat (PRS), Kalium, Natrium, Protein, Haematokrit, Blutdruck, Herzfrequenz und Körpergewicht nach je 2 Wochen Behandlung mit 2 mg Dexamethason; 25 mg Hydrocortison (HC); 25 mg HC+0,05 mg 9-α-Fluorohydrocortison (FC); 25 mg HC+0,1 mg FC und 25 mg HC+0,2 mg FC untersucht. Vier Patienten wurden weniger ausführlich untersucht. Der Mittelwert der PRA (normale obere Grenze, ambulant: 12 ng AT I·ml−1·h−1) war nach den 5 Substitutionsschritten, beginnend mit Dexamethason: 192; 59; 38, 24 und 9 ng AT I·ml−1·h−1. PRS zeigte keine signifikanten Änderungen. PRA und AT II korrelierten signifikant (r=0,91;p<0,0001) und zeigten eine mangelhafte Substitution am empfindlichsten an. Mit abnehmender Signifikanz korrelierte PRA mit der Plasma-Proteinkonzentration, der Plasma-Natriumkonzentration (negativ), der Gewichtsänderung, der Herzfrequenz, der Blutdruckänderung (negativ) und der Plasma-Kaliumkonzentration.

Die Messung von PRA oder AT II ist anderen Methoden der Kontrolle der Mineralocorticoid-Substitution überlegen. Zur Vermeidung einer Überdosierung sollte die PRA im oberen Normbereich gehalten werden.

Summary

In 7 out-patients with Addison's disease, plasma renin activity (PRA), plasma concentrations of angiotensin II (AT II), renin substrate (PRS), potassium, sodium and total protein, hematocrit, blood pressure, heart rate and body weight were studied after 2 weeks each on 2 mg of dexamethasone, 25 mg hydrocortisone (HC), 25 mg HC+0.05 mg 9-α-fluorohydrocortisone (FC), 25 mg HC+0.1 mg FC and 25 mg HC+0.2 mg FC. Four further patients were less extensively studied. Mean PRA (upper normal limit, ambulatory: 12 ng AT I·ml−1·h−1) after the 5 steps of incremental substitution, starting with dexamethasone, was 192, 59, 38, 24 and 9 ng AT I·ml−1·h−1 rsp. PRS did not change with increasing substitution. PRA and AT II were significantly correlated (r=0.91;p<0.0001) and proved to be the most sensitive parameters of insufficient mineralocorticoid substitution. With decreasing significance, PRA also correlated with plasma protein concentration, plasma sodium concentration (negative), Δ body weight (negative), heart rate, Δ mean blood pressure (negative) and plasma potassium concentration.

PRA or AT II measurements are useful clinical tools to control mineralocorticoid substitution in Addisonian patients. Inappropriately high substitution can be prevented by keeping PRA in the upper normal range.

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Authors and Affiliations

  1. Division of Endocrinology, Department of Internal Medicine, Klinikum Steglitz, Freie Universität Berlin, Germany

    W. Oelkers & M. L'age

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  1. W. Oelkers
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  2. M. L'age
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Supported by the Deutsche Forschungsgemeinschaft

Presented in part to the 21st Symposium of the Deutsche Gesellschaft für Endokrinologie, Munich, February 1975

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Oelkers, W., L'age, M. Control of mineralocorticoid substitution in Addison's disease by plasma renin measurement. Klin Wochenschr 54, 607–612 (1976). https://doi.org/10.1007/BF01469025

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