Response of several adrenal steroids to ACTH stimulation in essential hypertension

Plasma concentrations of progesterone (P), deoxycorticosterone (DOC), 17-hydroxyprogesterone (17-OH P), corticosterone (B), deoxycortisol (S), cortisol (F), and aldosterone were measured in 8 control subjects and in 10 patients with low and normal renin essential hypertension (EH) before and 4 and 8 h after an iv infusion of 25 units of ACTH. Secretion rates of 18-hydroxy-11-deoxycorticosterone (18-OH DOC) were measured for the 24 h prior to and the day of the ACTH infusions. The hypertensive patients had significantly higher plasma levels of aldosterone, DOC and S after ACTH than the controls, whereas plasma B levels were significantly lower. The low renin subgroup considered separately had significantly higher plasma levels of aldosterone and DOC than controls, and higher levels of B and lower levels of F than the normal renin subgroup in response to ACTH. Although not significantly different, the plasma levels of P and the secretion rate of 18-OH DOC tended to be higher, and plasma 17-OH P and F levels lower after ACTH in patients with EH than in controls. The low renin subgroup tended to have the highest plasma S levels and 18-OH DOC secretory rates and lowest F levels. Estimations of adrenal 11beta-hydroxylating efficiency in response to ACTH in patients and controls by plasma steroid ratios revealed significantly lower B/DOC ratios in both low and normal renin patients compared to controls, supported by somewhat lower F/S ratios in these patients, especially those in the low renin subgroup. Altered 17-hydroxylating efficiency seen by significantly lower 17-OH P/P ratios were also found in those with EH, supported by somewhat lower F/B and S/DOC ratios in these patients, agian especially in the low renin subgroup. These data are compatible with a pattern of altered adrenocortical steroid biosynthesis in essential hypertension bearing features similar to adrenal 11beta and 17alpha-hydroxylation deficiencies.

Effects of angiotensin II on steroid metabolism and hepatic blood flow in man

Metabolic clearance rates (MCR) of aldosterone, cortisol, 11-deoxycorticosterone (DOC), corticosterone, and progesterone were simultaneously measured by constant infusion in eight control subjects before and during angiotensin II infusion in subpressor (3 ng/min per kg) and pressor (22 ng/min per kg) doses. Plasma levels of aldosterone and cortisol, the heat-labile protein-bound fraction of aldosterone, and hepatic blood flow (HBF) (as estimated by the fractional clearance of indocyanine green) were determined concomitantly. Angiotensin II in a subpressor dose produced a significant decrease of the MCR of aldosterone (by 23%), cortisol (by 16%), DOC (by 26%), corticosterone (by 14%) and progesterone (by 33%). The pressor dose further decreased the respective MCR by 37%, 21%, 40%, 28%, and 42% of the baseline value. Plasma aldosterone levels rose by 317% with subpressor and by 434% with pressor doses. HBF decreased by 18% with subpressor and by 33% with pressor doses of angiotensin II. Furthermore, there were significant negative correlations between the MCR of each steroid and the respective values of the fractional clearance of indocyanine green. We conclude that angiotensin II, by its vasoconstrictive action on the splanchnic vascular bed, decreases the MCR of aldosterone, cortisol, DOC, corticosterone, and progesterone. This decrease has to be taken into account when considering the stimulatory effect of angiotensin II on various plasma steroid concentrations.

The mediation of tissue eosinophilia in hypersensitivity reactions. II. Separation of a delayed eosinophil chemotactic factor from macrophage chemotactic factors

In anaphylactic cutaneous lesions induced by DNP-ascaris extract in the guinea-pig, the time-course of delayed tissue eosinophilia was found to parallel that of the macrophage reaction, reaching its peak in 24 h. Macrophages could be differentiated from lymphocytes by the numerous lysosomal granules which stained for acid phosphatase. Extracts from such skin lesions contained a delayed eosinophil chemotactic factor and two different macrophage chemotactic factors. Most of the delayed eosinophil chemotactic factor was separated from the two macrophage chemotactic factors by gel filtration on Sephadex G-100 and Sephadex G-200 in that order. The eosinophil chemotactic factor after re-chromatography on Sephadex G-I99 showed no or little chemotactic activity for macrophages.

Leukonychia striae

A 19-year-old keypuncher had leukonychia striae. The pattern of striae suggested that they occurred as a result of the mechanical stimulation of keypunching.

Effects of ACTH on steroid metabolism

Metabolic clearance rates (MCR) of aldosterone, cortisol, DOC, corticosterone, and progesterone were simultaneously measured by constant infusion in 8 control subjects before and during an ACTH infusion (12.5 U/4 h). Plasma levels of aldosterone and cortisol, the heat-labile plasma protein-bound fraction of aldosterone, and hepatic blood flow as estimated by the fractional clearance of indocyanine green, were concomitantly determined. The mean MCR of aldosterone, cortisol, and DOC increased to a peak value of 26%, 23%, and 22%, respectively, above baseline values. The increase was already significant (P is less than 0.001) 30 min after the beginning of the ACTH infusion. In contrast, no consistent changes occurred in the MCR of corticosterone and progesterone or in hepatic blood flow. ACTH induced a marked fall in the heat-labile plasma protein-bound fraction of aldosterone. Plasma levels of aldosterone and corsitol increased by 190 and 250%, respectively. A significant negative correlation (r=-0.423, P is less than 0.01) between the MCR and the heat-labile protein-bound fraction of aldosterone was observed. We suggest that competitive interactions in the protein binding properties of various steroids account for the selective effect of ACTH on the MCR of aldosterone, cortisol, and DOC.

The operability of patient with pulmonary hypertension judged from hemodynamic changes before and after surgery

1) In congenital heart disease with pulmonary hypertension, the place for surgical correction still remains even with almost systemic PA pressure if R to L shunt ratio on lung scintigram is lower than 25%. 2) The patient with pulmonary hypertension in congenital heart disease younger than 3 years of age has wider acceptability for surgery compared to older patient. 3) In patients with mitral valvular disease, surgical correction seems to be indicated irrespective of PA pressure, if their preoperative U/L are lower than 2.4.

The simultaneous assay of progesterone, 17-hydroxyprogesterone, and deoxycorticosterone in human plasma by competitive protein binding

A method is described for the simultaneous measurement of prosterone (P), 17-hydroxyprogesterone (17-OHP) and deoxycorticosterone (DOC) in plasma by competitive protein-binding assay. After extraction, these steroids were purified by Sephadex LH-20 columns. The methods described here is sensitive enough to detect the above-mentioned steroids in as little as 5 ml of plasma under physiological conditions. The mean physiological plasma level (ng/100 ml) of P, 17-OHP and DOC are 18.2+/-1.6 (SE), 136.5+/-11.7, and 8.6+/-1.0 in men, 14.7+/-1.7, 61,2+/-3.6 and 6.0+/-1.2 in women in the follicular phase, and 645.0+/-108.1, 155.2+/-16.9, and 7.5+/-1.2, in the luteal phase of the menstrual cycle. By this method and others, the responses of plasma levels of 7 adrenal steroids (P, 17-OH, doc, corticosterone, deoxycortisol, cortisol and aldosterone) to ACTH infusion (25U i.v. over 8 hours) were investigated in healthy men. The increase of DOC was more pronounced than that of the other steroids.

Effects of ACTH on plasma levels of adrenal steroids in essential hypertension

Plasma concentrations of progesterone (P), deoxycorticosterone (DOC), 17-hydroxyprogesterone (17-OH P), corticosterone (B), deoxycortisol (S), cortisol (F) and aldosterone (A) in 8 control subjects (mean age: 40.5 years) and 10 patients with essential hypertension (EH) (mean age: 48.5 years) were determined before, 4 and 8 hours after an infusion of ACTH at a rate of 25 units per 8 hours. Secretion rates (SR) of 18-hydroxy-11-deoxycorticosterone (18-OH DOC) were measured 24 hours before and again on the day of ACTH infusion. All subjects were studied on the fourth day of a diet containing 135 mEq of sodium and 90 mEq of potassium. There was no statistically significant difference between 8 control subjects and 10 patients with EH in the 7 plasma steroid levels and the SR of 18-OH DOC before ACTH infusion. The mean plasma P response to ACTH was slightly lower in controls than in patients with EH, while that of 17-OH P (in male subjects) was slightly higher. The mean plasma B response was significantly lower after 4 hours of ACTH infusion (p less than 0.01), while that of DOC was significantly higher after 8 hours of ACTH infusion (p less than 0.05) in patients with EH. The mean plasma S rose significantly more in patients with EH (p less than 0.025) at 4 and 8 hours after ACTH infusion. The mean plasma F response to ACTH infusion was slightly lower in patients with EH than in controls. The mean response of 18-OH DOC SR to ACTH infusion was slightly higher in patients with EH than in controls. The mean plasma A response was significantly higher in patients with EH than in controls 4 (p less than 0.05) and 8 hour (p less than 0.001) after an ACTH infusion. These results could be explained in part by abnormalities in the 17- and 11-hydroxylase systems, and that the abnormality in 11-hydroxylation was more pronounced than that in the 17-position. Furthermore, we suspect that the sensitivity of adrenal aldosterone to ACTH might be increased or another accelerated pathway to aldosterone biosynthesis might exist in patients with EH.

Mineralocorticoid secretion in essential hypertension with normal and low plasma renin activity

In 19 control subjects, 33 patients with essential hypertension and normal plasma renin activity (PRA) and 11 patients with low PRA, secretory rates of 18-hydroxy-11-deoxy-corticosterone (18-OH DOC), 11-deoxycorticosterone (DOC) and corticosterone were measured. Patients with low PRA were significantly older and had higher arterial pressure and slightly lower plasma potassium levels than patients with normal PRA. Mean 18-OH DOC secretion rate was higher in patients with normal PRA (603 +/- 112 SEM mug/24 hr) than in control subjects (219 +/- 19) and considerably higher (P less than 0.001) in patients with low PRA (1800 +/- 472). DOC and corticosterone secretion rates were within normal limits in most hypertensive patients. Plasma aldosterone was significantly higher in the hypertensive population than in control subjects whereas no significant difference was observed between the low- and normal-renin groups. A significant (P less than 0.01) mutual positive correlation was found between the secretion rates of 18-OH DOC, DOC and corticosterone in patients with low plasma renin activity. In contrast, there was no correlation between the secretion rates of the three mineralocorticoids in control subjects and patients with normal plasma renin activity. These data suggest a biosynthetic variation of the mineralocorticoid pathways in essential hypertension.

Hypertension with renal arterial stenosis: humoral, hemodynamic and histopathologic factors

In 46 hypertensive patients with unilateral renal arterial stenosis, peripheral and renal venous plasma renin activity, juxtaglomerular cell count and granularity and systolic pressure gradient across the stenosis were determined. After corrective surgery and a mean postoperative observation period of 4.3 years, 18 patients were completely relieved of hypertension (good responders), 14 had a substantial reduction in arterial pressure (fair responders) and 14 remained hypertensive (poor responders). Analysis of plasma renin activity in both renal veins indicated that a ratio (stenotic/nonstenotic side) greater than 2.0 correctly predicted a favorable surgical result in all cases. Peripheral plasma renin activity was greater than normal in 65 percent of good responders, in 50 percent of fair responders and in one nonresponder. The prognostic accuracy of a pressure gradient greater than 40 mm Hg was 78 percent; no patient with a gradient of less than 40 mm Hg benefited from surgery. An increased juxtaglomerular cell count on the affected side predicted a successful operative result in 88 percent, as did increased granularity in 85 percent of cases. Renal venous renin ratio correlated positively (r =0.738, P less than 0.001) with the pressure gradient across the stenosis. The renal venous plasma renin activity of the affected side also correlated positively (r = 0.771, P less than 0.001) with the absolute count of granular cells in the juxtaglomerular apparatus. Plasma renin activity in both renal veins is the most reliable predictor of operative outcome. The addition of juxtaglomerular cell count or pressure gradient across the stenosis increases prognostic accuracy only slightly. The close mutual correlations between renal venous renin ratio, pressure gradient and juxtaglomerular cell count support the experimental evidence of a causal relation between the hemodynamic effects of the arterial lesion and the humoral and histologic changes observed in hypertension with renal arterial stenosis.

Splanchnic blood flow in essential hypertension and in hypertensive patients with renal artery stenosis

Splanchnic blood flow (SBF) was measured simultaneously with cardiac output (dye dilution) and intrarterial blood pressure by constant infusion of indocyanine green in 11 control subjects, 13 patients with essential hypertension (EH) and seven hypertensive patients with renal artery stenosis (RAS). The cardiac index (CI) was lower (P less than 0.05) in patients with EH (3.17 plus or minus 0.07 L/min/m-2) (mean plus or minus SEM) than in control subjects (3.43 plus or minus 0.09). Associated with the lower CI was a significantly (P less than 0.01) lower SBF (0.797 plus or minus 0.02 L/min/m-2 vs 0.889 plus or minus 0.04). Patients with RAS presented with higher (P less than 0.01 vs EH, nonsignificant vs control subjects) cardiac index (3.66 plus or minus 0.17) and even lower SBF (0.749 PLUS OR MINUS 0.02). Furthermore, there was a negative correlation (r = - 0.652) between the mean arterial pressure and the SBF when results for all patients were considered. The correlation remained (r = - 0.568) in the EH group and the slope of regression line was not different from that for all subjects. The CI and SBF were weakly correlated (r = 0.423) in control subjects and patients with EH, whereas in patients with RAS, a negative correlation was found (r = - 0.778). This study indicates that the SBF, although significantly decreased in patients with EH, remains proportional to the CI in control subjects and in essential hypertensive patients. No redistribution of CI in regard to the splanchnic circulation occurs in EH. In contrast, in patients with RAS a dissociation of CI and SBF occurs and the fraction of the CI which passes through the splanchnic vascular bed is markedly reduced. The close correlation between mean arterial pressure and SBF suggests that both parameters are influenced by a common pathophysiological factor.