TY - JOUR
T1 - Correction of hyperaldosteronism and of massive fluid retention of unknown cause by sympathomimetic agents
AU - Greenough, William B.
AU - Sonnenblick, Edmund H.
AU - Januszewicz, Vlodzimierz
AU - Laragh, John H.
N1 - Funding Information:
M . S . (CPMC Unit No . 134-20-13), a thirty-nine year old unmarried woman, who was an advertising copywriter, was admitted to the Columbia-Presbyterian Medical Center for the sixth time on April 10, 1959, with increasing asthenia, orthostatic hypotension and the third episode within eight months of reversible hypokalemia with azotemia . (Fig . 1 .) The patient had developed normally through childhood with onset of menses at the age of twelve years. There was cessation of menses for brief periods with stress, but she continued well until the age of eighteen years. Easy bruisabi]ity and occasional epistaxis bad been noted intermittently throughout * From the Department of Medicine, Columbia University : College of Physicians and Surgeons and The Presbyterian Hospital, New York, Ncw York . This work was supported by a grant from the U . S . Public Health Service. (H-1275) and by the Chichester duPont Foundation, Inc. -Manuscript received October 30, 19611 t Present address : The Mary Imogene Bassett Hospital, Cooperstown, New York. $ Present address : National Institutes of Health, National Heart Institute, Bethesda, Maryland . § Fellow of the Rockefeller Foundation, 1959 . Present address : II Medical Clinic Academy, Warsaw, Nuwogrodzka 59, Poland.
PY - 1962/10
Y1 - 1962/10
N2 - A detailed study is reported of a thirty-nine year old woman with long-standing postural hypotension and recurrent episodes of massive anasarca. Later, periods of edema formation alternated with bouts of dehydration, azotemia and potassium depletion, and evidences of impaired renal function appeared. The episodes of sodium retention and edema formation were demonstrated to be associated with a marked increase in the adrenal secretory rate of aldosterone. The increased secretion of aldosterone was paradoxic because it occurred despite a relatively high sodium intake. Sustained diuresis was induced by a spirolactone dldosterone antagonist, providing evidence that aldosterone oversecretion was important in causation of the edematous state. Complete correction of the disorder during a prolonged period of observation was finally achieved by oral administration of sympathomimetic agents. Administration of these pressor agents produced a fall in the rate of secretion of aldosterone to normal values and a marked sodium diuresis. Potassium excretion did not increase. The nature of the disorder has not been elucidated. However, the patient was found to have hypervolemia and a markedly reduced glomerular filtration rate. It has been suggested that her arterial hypotension might be a result of venous pooling. The beneficial effects of the sympathomimetic drugs are viewed as a consequence of a direct or indirect action to improve the renal circulation, leading to suppression of the generation of an aldosterone stimulating factor (? angiotensin).
AB - A detailed study is reported of a thirty-nine year old woman with long-standing postural hypotension and recurrent episodes of massive anasarca. Later, periods of edema formation alternated with bouts of dehydration, azotemia and potassium depletion, and evidences of impaired renal function appeared. The episodes of sodium retention and edema formation were demonstrated to be associated with a marked increase in the adrenal secretory rate of aldosterone. The increased secretion of aldosterone was paradoxic because it occurred despite a relatively high sodium intake. Sustained diuresis was induced by a spirolactone dldosterone antagonist, providing evidence that aldosterone oversecretion was important in causation of the edematous state. Complete correction of the disorder during a prolonged period of observation was finally achieved by oral administration of sympathomimetic agents. Administration of these pressor agents produced a fall in the rate of secretion of aldosterone to normal values and a marked sodium diuresis. Potassium excretion did not increase. The nature of the disorder has not been elucidated. However, the patient was found to have hypervolemia and a markedly reduced glomerular filtration rate. It has been suggested that her arterial hypotension might be a result of venous pooling. The beneficial effects of the sympathomimetic drugs are viewed as a consequence of a direct or indirect action to improve the renal circulation, leading to suppression of the generation of an aldosterone stimulating factor (? angiotensin).
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U2 - 10.1016/0002-9343(62)90268-1
DO - 10.1016/0002-9343(62)90268-1
M3 - Article
C2 - 13950198
AN - SCOPUS:0344389582
SN - 0002-9343
VL - 33
SP - 603
EP - 614
JO - American Journal of Medicine
JF - American Journal of Medicine
IS - 4
ER -