Randomised clinical non-inferiority trial comparing two formulations of desoxycortone pivalate for the treatment of canine primary hypoadrenocorticism

BACKGROUND

This clinical trial compared two formulations of desoxycortone pivalate (DOCP) for treating the mineralocorticoid deficit in dogs with primary hypoadrenocorticism (PH).

METHODS

At veterinary clinics in the USA and France, dogs with PH (n=152) were randomised (3:1) to receive approximately monthly treatments with either the test product, Zycortal (Dechra), administered subcutaneously (n=113), or the control product, Percorten-V (Novartis Animal Health), administered intramuscularly (n=39), both at an initial dose of 2.2 mg/kg DOCP. Treatment administrators were unblinded; veterinarians assessing clinical signs were blinded; owners were blinded until at least day 90, the primary end point. Veterinarians assessed treatment outcome based on all of the following: clinical signs; sodium concentrations; potassium concentrations. Dogs received concurrent glucocorticoid therapy throughout the trial. Non-inferiority was assessed using a generalised linear mixed model to compare success rates between groups.

RESULTS

Success rates at day 90 were similar between groups (per-protocol population at day 90: Zycortal 87/101, 86.2 per cent, Percorten-V 29/34, 85.1 per cent). Zycortal was non-inferior to Percorten-V as the upper limit of the 95 per cent CI for the difference between groups was 13.6 per cent. Polydipsia and polyuria were the most common clinical observations.

CONCLUSION

Both products, in combination with glucocorticoid therapy, were safe and effective in treating PH.

Successful treatment of a cat with primary hypoadrenocorticism and severe hyponatremia with desoxycorticosterone pivalate (DOCP)

A 6-year-old, castrated male Siamese cat was diagnosed with primary hypoadrenocorticism, confirmed by an adrenocorticotopic hormone (ACTH) stimulation test documenting both hypocortisolism and hypoaldosteronism. The cat was successfully treated using a combination of prednisolone and desoxycorticosterone pivalate (DOCP). This case demonstrates that DOCP can be used successfully as mineralocorticoid supplementation in cats with hypoadrenocorticism and may have a longer therapeutic duration than that in dogs.

Pharmacologically induced thoracic and abdominal aortic aneurysms in mice

Aortic aneurysms are common among the elderly population. A large majority of aortic aneurysms are located at two distinct aneurysm-prone regions, the abdominal aorta and thoracic aorta involving the ascending aorta. In this study, we combined two factors that are associated with human aortic aneurysms, hypertension and degeneration of elastic lamina, to induce an aortic aneurysm in mice. Roles of hemodynamic conditions in the formation of aortic aneurysms were assessed using two different methods for inducing hypertension and antihypertensive agents. In 9-week-old C57BL/6J male mice, hypertension was induced by angiotensin II or deoxycorticosterone acetate-salt hypertension; degeneration of elastic lamina was induced by infusion of beta-aminopropionitrile, a lysyl oxidase inhibitor. Irrespective of the methods for inducing hypertension, mice developed thoracic and abdominal aortic aneurysms (38% to 50% and 30 to 49%, respectively). Aneurysms were found at the two aneurysm-prone regions with site-specific morphological and histological characteristics. Treatment with an antihypertensive agent, amlodipine, normalized blood pressure and dramatically reduced aneurysm formation in the mice that received angiotensin II and beta-aminopropionitrile. However, treatment with captopril, an angiotensin-converting enzyme inhibitor, did not affect blood pressure or the incidence of aortic aneurysms in the mice that received deoxycorticosterone acetate-salt and beta-aminopropionitrile. In summary, we have shown that a combination of hypertension and pharmacologically induced degeneration of elastic laminas can induce both thoracic and abdominal aortic aneurysms with site-specific characteristics. The aneurysm formation in this model depended on hypertension but not on direct effects of angiotensin II to the vascular wall.

Sepsisähnliches Krankheitsbild bei Immunsuppression nach früherem Mallorcaurlaub

In immunosuppressed patients, a high rate of complications due to opportunistic infection is known. We report the case of a 36 year old patient with ulcerative colitis and a septic complication with ongoing pancytopenia. Due to colonic perforation, colectomy had to be performed. Despite this intervention, the septic constellation persisted. The pancytopenia in peripheral blood counts also persisted with the necessity of repetitive transfusions. A bone marrow biopsy showed an infiltration with Leishmania bodies in macrophages. Tissue culture allowed for typing of the parasites as belonging to the L. donovani/infantum complex, DNA sequencing confirmed infection with L. infantum. This infection must have been contracted during a vacation on Mallorca about 1.5 years earlier. Administration of liposomal amphotericin B cured the patient. Surprisingly, histological examination of the resected colon reveiled the presence of an immunoblastic B-cell lymphoma. In this case, immunosuppression was a prerequisite for the manifestation of leishmaniosis.

Anticonvulsant actions of deoxycorticosterone

PURPOSE

Adrenocorticotrophic hormone (ACTH) suppresses several types of childhood seizures, but it has many side effects. The mechanism of ACTH's anticonvulsant actions is not known. ACTH, however, releases deoxycorticosterone (DOC) - as well as cortisol - from the adrenal cortex and it has been suggested that DOC may mediate, at least in part, ACTH's anticonvulsant actions. The present study assessed DOC's anticonvulsant actions in infant rats. Age-related changes in DOC's anticonvulsant actions were also studied.

METHODS

DOC's anticonvulsant actions were assessed against hippocampal-kindled, maximal pentylenetetrazol test (MMT) and maximal electroshock (MES) seizures in 15-day-old rats. Age-related changes in responsiveness to DOC were also assessed using the MMT model.

RESULTS

DOC suppressed generalized convulsions in all three of the seizure models. Focal spiking in the hippocampal-kindling model, however, was not fully suppressed, even at high doses. Ataxia increased proportionally with the dose, with the time of peak seizure suppression roughly correlating with the time of peak ataxia in all models. DOC was anticonvulsant in both infant and adult rats. ED50s, however, were much higher in adults. Young rats showed ataxia at the time of testing (15 min), whereas adult rats did not, although ataxia was seen at later times.

CONCLUSIONS

DOC is a potent anticonvulsant against generalized seizures, particularly in infants. It deserves a clinical test against generalized seizures in infants.

Deoxycorticosterone's anticonvulsant effects in infant rats are blocked by finasteride, but not by indomethacin

Deoxycorticosterone (DOC) is a steroid hormone that suppresses seizures in both humans and animals. At higher doses, DOC's anticonvulsant actions are accompanied by sedation and ataxia. The mechanism of DOC's anticonvulsant actions is not known, although it has been suggested that they may relate to DOC's secondary metabolite 3-alpha-5-alpha-tetrahydrodeoxycorticosterone (THDOC). The present study was designed to study the relation of DOC's anticonvulsant actions to its primary and secondary metabolites in 15-day-old rats. It was found that DOC's anticonvulsant and ataxic effects were suppressed by finasteride, which blocks the formation of DOC's primary metabolite, 3-alpha-5-alpha-dehydrodeoxycorticosterone (DHDOC). They were not suppressed by indomethacin (INDO), which blocks the conversion of DHDOC into THDOC. The direct anticonvulsant effects of DHDOC and THDOC were also tested. DHDOC and THDOC were both potent anticonvulsants in 15-day old rats. Both also caused ataxia at high doses. DHDOC had a therapeutic index (TI) of 3.2, however, which was better than either DOC (TI = 1.2) or THDOC (TI = 1.5). It appears that DOC itself is not anticonvulsant, but that its anticonvulsant effects may relate to both its primary and secondary metabolites. DOC's primary metabolite, DHDOC--with its good TI--deserves a test in the treatment of childhood seizures.

Anticonvulsant action of three neurosteroids against cortical epileptic afterdischarges in immature rats

Neurosteroids exhibit anticonvulsant action probably by positive modulatory influence on GABA-A receptors. The action of three neurosteroids was tested against cortical epileptic afterdischarges in immature rats with implanted electrodes. Afterdischarges (ADs) were elicited by rhythmic electrical stimulation (biphasic pulses at 8 Hz frequency for 15s) of sensorimotor cortical region with a slightly suprathreshold current intensity. Drugs were administered intraperitoneally after the first afterdischarge and stimulation was repeated five more times with the same intensity. Allopregnanolone in doses of 20 and 30 mg/kg i.p. was found to be active in 12-day-old rats; there was no effect in 18-day-old rats and only a tendency in 25-day-old ones. Therefore, the effects of pregnanolone and a new derivative THDOC-conjugate (20 and 40 mg/kg) were compared with those of allopregnanolone (40 mg/kg) only in 12- and 25-day-old rats in the second part of study. All three neurosteroids blocked progressive prolongation of repeated ADs seen in control 12-day-old rats. In addition, pregnanolone was able to shorten the ADs. In contrast, duration of ADs in 25-day-old animals was significantly shorter than the duration of the first, predrug AD only after administration of the 40 mg/kg dose of pregnanolone; if corresponding ADs in the control and drug groups were compared, pregnanolone and THDOC-conjugate led to significantly shorter ADs, changes after allopregnanolone administration were statistically significant only in the fourth AD. None of the studied neurosteroids was able to suppress movements directly bound to stimulation as well as clonic seizures accompanying afterdischarges. Among the three drugs studied, pregnanolone was found to be the most potent one. As developmental changes are concerned, the youngest animals exhibited the highest sensitivity to anticonvulsant action of neurosteroids.

Neurosteroids and infantile spasms: the deoxycorticosterone hypothesis

Deoxycorticosterone (DOC) is a mineralocorticoid precursor that has anticonvulsant properties in animals and possibly also in humans. Studies indicate that the anticonvulsant activity of DOC requires its enzymatic conversion to 5 alpha,3 alpha-tetrahydrodeoxycorticosterone (THDOC), a neurosteroid that lacks classical hormonal properties but acts as a powerful positive allosteric modulator of GABAA receptors. DOC can be considered a stress hormone because its synthesis is under the control of ACTH. Therefore, stress-induced fluctuations in seizure susceptibility could in part result from alterations in DOC availability. Also, the therapeutic activity of ACTH in infantile spasms could partially relate to its stimulatory effects on the synthesis of DOC, which then undergoes biotransformation to neurosteroids. The recent demonstration that the synthetic neurosteroid analog ganaxolone reduces spasm frequency in children with intractable infantile spasms suggests that neurosteroid-related anticonvulsants may offer a potential new nonhormonal approach for the treatment of infantile spasms and other developmental epilepsies. In addition, it further confirms the utility of pharmacological enhancement of GABA-mediated inhibition in the control of infantile spasms.

Muscle cramps in two standard poodles with hypoadrenocorticism

Two standard poodles were evaluated for painful, episodic muscle cramps affecting their thoracic and pelvic limbs. Both dogs had been diagnosed with hypoadrenocorticism and were being treated with fludrocortisone acetate and prednisone when evaluated for muscle cramps. However, the muscle cramping started approximately 1 month prior to the diagnosis of hypoadrenocorticism. Findings on general physical examination included lethargy and dehydration. Neurological examination was normal between episodes. Serum biochemical abnormalities included hyperalbuminemia, azotemia, hyponatremia, hypochloremia, and hyperkalemia. Altering treatment to desoxycorticosterone pivalate resolved the electrolyte abnormalities and the episodes of muscle cramping in both dogs. The authors conclude that hypoadrenocorticism can be associated with episodes of painful muscle cramping in standard poodles.

Dose-, time-, age-, and sex-response profiles for the anticonvulsant effects of deoxycorticosterone in 15-day-old rats

Recently, we have shown that a single high dose of the adrenal steroid precursor hormone deoxycorticosterone (DOC) has potent anticonvulsant effects in 15-day-old rats. To better define the actions of DOC, the present study established dose-, time-, age-, and sex-response curves for the anticonvulsant actions of DOC. Methods. Dose- and time-response studies were done using two different seizure models: (1) maximal pentylenetetrazol seizures (MMT) and (2) maximal electroconvulsive shock (MES) seizures. Subsequently, age- and sex-response studies were done using MMT seizures and two different DOC doses, one low (nonsedating) and one high (sedating). Results. In dose-response studies, DOC suppressed MMT seizures with an ED(50) of about 5 mg/kg (sc). Higher doses were necessary to suppress MES seizures, where the ED(50) was about 20 mg/kg. In time-response studies, DOC's effects were rapid in onset. Complete suppression of seizures was seen by 5 min in the MES model and by 15 min in the MMT model. In developmental studies, both a low nonsedating and a high sedating dose of DOC suppressed MMT seizures in neonatal, infant, weanling, and juvenile rats of either sex. The suppressive effects of low-dose DOC were lost after puberty, however. The suppressive effects of high-dose DOC also declined after puberty, especially in males. Conclusion. DOC has significant anticonvulsant actions that occur in prepubertal, but not postpubertal subjects. DOC might have clinical importance in the future treatment of childhood seizure disorders.

[Immunomodulation after keratoplasty by CTL4-Ig and anti-CD154 antibodies]

BACKGROUND

The immunoreaction after corneal transplantation is caused by the T cell receptor interacting with the major histocompatibility complex (MHC) receptor of the antigen-presenting cell. The signal is amplified by the CD4 receptor and the costimulatory signal interactions of CD28-B7 and CD40-CD154. We investigated the influence of costimulatory signal blocking on corneal transplant survival in mice.

METHODS

Seven groups of 6 BALB/c mice received an orthotopic corneal transplant from C3H mice differing in minor and major MHC and were postoperatively treated as follows: (1) 80 micrograms of CTLA4 fusion protein intraperitoneally (i.p.) for 6 days; (2) 50 microliters of PBS i.p. for 6 days; (3) 1 mg of Solu-Decortin H i.p. for 5 days + dexamethasone AT 0.1% for 35 days; (4) therapy (3) + 50 micrograms of CTLA4 fusion protein i.p. for 6 days; (5) CTLA4-Ig as in (1) + 15 micrograms of anti-CD154 subconjunctivally (s.c.) on days 0, 2, 4, 6, and 8; (6) CTLA4-Ig as in (1) + 25 micrograms of anti-CD154 s.c. for 9 days; and (7) 25 microliters of PBS s.c. for 9 days.

RESULTS

All animals had an immunoreaction on the following days: (1) day 18 +/- 3.1; (2) day 13.6 +/- 1.6; (3) day 48 +/- 6.6; (4) day 65 +/- 41; (5) day 23.5 +/- 8.5; (6) day 16.2 +/- 3.6; (7) day 13.8 +/- 2.7.

CONCLUSION

The significant prolongation of transplant survival achieved by corticosteroids alone (P < 0.001) is again significantly increased by combining them with CTLA4-Ig (P < 0.001). Specific immunotherapy combined with nonspecific steroid therapy may also improve clinical corneal transplantation results. Compared to the two control groups, CTLA4-Ig and anti-CD154 only influenced transplant survival at a low dosage (P < 0.001).

Effects of naloxone, glycyrrhizic acid, dexamethasone and deoxycorticosterone in repetitive stress

1. The present study examined the effect of naloxone (NAL), glycyrrhizic acid (GCA), deoxycorticosterone (DOC) and dexamethasone (DEX) on daily repeated 2 h chronic restrained stress (RS) on the locomotor activity (LA) of rats tested in the open field arena to elucidate the possible roles of opioids, glucocorticoids and mineralocorticoids in response to stress. 2. Intact and adrenalectomized (ADX) rats were either injected with 0.1 mL of NAL (0.32 microgram/100 g BW), 2.4 mg/kg DOC or 120 micrograms/kg DEX or had 1.0 mg/mL GCA dissolved in their drinking water or normal saline (for the ADX group) dissolved in their drinking water. 3. In intact groups, treatment with NAL completely blocked the stress response and treatment with GCA, DOC and DEX partially prevented the stress response. Adaptation occurred on either days 4, 5, 6 or 7 for intact rats treated with DEX, DOC, GCA or control rats, respectively. All ADX control rats died following the first 2 h RS. Adrenalectomized rats treated with DEX or DOC adapted later compared with intact rats, while rats given either GCA or NAL were unable to block or adapt to chronic RS. 4. These findings demonstrate that the stress response is primarily mediated by endogenous opioids, in that it is blocked by NAL. Both mineralocorticoids and glucocorticoids, which can act centrally to inhibit endorphins, partially blocked the stress response. The effect of GCA in intact rats was similar to that of both DEX and DOC in intact rats. Adrenalectomized rats treated with GCA (despite their lack of endogenous corticosterone) showed a stress response that was significantly different from the other ADX groups, implying that GCA had effects independent of endogenous corticosterone.

Treatment and long-term follow-up of 205 dogs with hypoadrenocorticism

Results of long-term treatment were evaluated in 200 dogs with primary hypoadrenocorticism and 5 dogs with spontaneous secondary hypoadrenocorticism. Fludrocortisone acetate initially was used for mineralocorticoid replacement in 190 of the dogs with primary hypoadrenocorticism. The daily dose of fludrocortisone required in these dogs increased significantly during the treatment period (median, 2.6 years) from an initial median dose of 13.1 micrograms/kg to a final dose of 22.6 micrograms/kg. In 27 of the 200 dogs, mineralocorticoid therapy was changed from fludrocortisone to desoxycorticosterone pivalate (DOCP) because of adverse effects,poor response, or financial considerations. The dose of DOCP required in the 33 dogs (27 dogs plus 6 dogs initially given DOCP) increased significantly during the treatment period (median, 3.5 years) from an initial median dose of 1.56 mg/kg to a final dose of 1.69 mg/kg; the interval between DOCP injections ranged from 14 to 35 days (median, 30 days). The dose of prednisone administered to the dogs with primary hypoadrenocorticism decreased significantly from an initial median dose of 0.3 mg/kg to a final dose of 0.2 mg/kg; the drug was discontinued in 22 dogs due to adverse effects. The 5 dogs with secondary hypoadrenocorticism received only glucocorticoid replacement therapy (prednisone) at initial and final daily dosages of 0.41 mg/kg and 0.25 mg/kg, respectively, during a median treatment period of 4.4 years. More than 80% of the dogs were considered to have a good to excellent response to therapy. The median survival time of all 205 dogs was 4.7 years. There were no differences in response to treatment or survival between dogs treated with fludrocortisone and those receiving DOCP, or between dogs with primary hypoadrenocorticism and those with secondary hypoadrenocorticism.

Subcutaneous administration of desoxycorticosterone pivalate for the treatment of canine hypoadrenocorticism

Twelve dogs with hypoadrenocorticism were treated with subcutaneous desoxycorticosterone pivalate (DOCP). Eight of these dogs were recently diagnosed and had not yet been treated. Four dogs previously had been diagnosed and treated (three with intramuscular DOCP, one with oral fludrocortisone acetate). History, physical examination, serum electrolytes, and blood urea nitrogen (BUN) were evaluated. Desoxycorticosterone pivalate (2.2 mg/kg body weight) was administered every 25 days. On day 0, recently diagnosed dogs had a median serum sodium concentration of 131.5 mEq/L, median serum potassium concentration of 6.6 mEq/L, and median BUN of 41.5 mg/dl. All subsequent median serum electrolyte and BUN concentrations were normal. All previously treated dogs had normal blood values which were maintained throughout the study.

Effects of desoxycorticosterone pivalate administration on blood pressure in dogs with primary hypoadrenocorticism

A study was designed to evaluate the effects of desoxycorticosterone pivalate (DOCP) on blood pressure in 8 dogs with primary hypoadrenocorticism, and to attempt to identify other factors that might suggest overdosage of the drug. In 4 dogs, primary hypoadrenocorticism had been diagnosed immediately before entry of the dog into the study, and the dogs had not received any mineralocorticoid supplementation. In the other 4 dogs, primary hypoadrenocorticism had been diagnosed 1 to 6 years previously, and dogs were being treated with DOCP at the time of entry into the study. In all 8 dogs, DOCP (2.2 mg/kg of body weight, IM) was administered on days 0, 30, 60, and 90 of the study; each dog was examined on days 0, 30, 60, 75, 90, and 105. At the time of each visit, a medical history was obtained, a complete physical examination and serum biochemical analyses were performed, and body weight and blood pressure were measured. Doppler-shift ultrasonic sphygmomanometry was used to indirectly record systemic systolic and diastolic pressures. None of the dogs developed hypernatremia or hypokalemia or any clinical signs suggestive of hypoadrenocorticism during the study. However, in 6 dogs (3 that had not been previously treated with mineralocorticoids and 3 that had been), there was a significant increase in body weight over the course of the study. Compared with baseline (day 0) arterial blood pressure, neither systolic nor diastolic blood pressure was significantly increased during the study, and all systolic and diastolic blood pressure measurements were within reference ranges at all evaluation times.(ABSTRACT TRUNCATED AT 250 WORDS)

Desoxycorticosterone pivalate in the management of canine primary hypoadrenocorticism

Primary hypoadrenocorticism in dogs may be poorly responsive to oral fluorocortisone treatment. Desoxycorticosterone pivalate is a suggested alternative treatment in these and all other cases of hypoadrenocorticism. Primary hypoadrenocorticism was diagnosed in a 3-year-old Cocker Spaniel bitch. Treatment with oral fluorocortisone at a dose rate of 0.13 mg 5 kg-1 d-1 was ineffective at maintaining serum electrolyte concentrations within normal limits. Administration of DOCP at a dose of 1.6-2.2 mg kg-1 intramuscularly every 28 d over a 5-year period, successfully maintained normal serum sodium and potassium concentrations. Side-effects encountered were minimal and were dose- or disease-related.

Roles of hemodynamic and tubular factors in gentamicin-mediated nephropathy

Gentamicin (GM) often causes polyuric acute renal failure (ARF) in humans and animals. GM-mediated ARF in rats was accompanied with activated renin-angiotensin system, increased renal endothelin content, and enhanced lipid peroxidation. Suppression of the renin-angiotensin activity by desoxycorticosterone acetate and saline drinking, and treatment with superoxide dismutase attenuated the GM-induced decline in whole-kidney GFR with well-maintained RBF but did not reduce the severity of tubular necrosis. On the other hand, treatment with dimethylthiourea, a hydroxyl radical scavenger, attenuated the GM-mediated decline in GFR and lessened tubular necrosis but did not ameliorate the reduction in RBF. These data suggest contributions of both vascular and tubular factors to the GM-induced decline in GFR in rats. However, relative importance of these factors probably differs with different doses of the agent.

Efficacy of microcrystalline desoxycorticosterone pivalate for treatment of hypoadrenocorticism in dogs. DOCP Clinical Study Group

The efficacy of microcrystalline desoxycorticosterone pivalate (DOCP) therapy was evaluated in 60 dogs with hypoadrenocorticism. Fifty-one of the dogs were being treated with either DOCP or fludrocortisone acetate prior to entering the study. The disease had been recently diagnosed in 9 dogs that were not under maintenance treatment prior to entering the study. Desoxycorticosterone pivalate (2.2 mg/kg of body weight, IM) was administered on days 0, 25, and 50. Physical examination was performed, and blood samples were obtained for serum biochemical analysis (Na+, K+, and BUN concentrations) on days 0, 14, 25, 39, 50, 64, and 75. On day 75 of the study, a final physical examination was performed and the course of treatment was evaluated. Sixty-eight percent (41/60) of the dogs had normal physical findings on day 0 vs 87% (52/60) on day 75. Mean (+/- SD) body weight increased from 24.8 +/- 12.7 kg on day 0 to 26.2 +/- 13.7 kg on day 75. Mean serum Na+ (137.7 +/- 8.5 mEq/L) and K+ (5.6 1.0 mEq/L) concentrations and Na(+)-to-K+ ratio (25.4 +/- 5.0:1) were outside normal reference limits on day 0. By day 75, serum Na+ (144.3 +/- 4.8 mEq/L) and K+ (4.9 +/- 0.8 mEq/L) concentrations and Na(+)-to-K+ ratio (30.4 +/- 5.1:1) were normal and were significantly (P < 0.01) improved, compared with the corresponding values on day 0. Of the 60 dogs, 58 (97%) regained the loss in body weight, appetite, and muscular strength while given DOCP; once achieved, these improvements were maintained. These 58 dogs did not vomit or have diarrhea, common problems in dogs with hypoadrenocorticism.(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of high calcium intake on Ca2+ ATPase and the tissue Na:K ratio in spontaneously hypertensive rats

The effects of oral calcium loading on the development of hypertension were studied in spontaneously hypertensive rats (SHR). Forty-eight male SHR were divided into four groups according to treatment: control, calcium, deoxycorticosterone (DOC) and DOC + calcium. Both calcium groups received ad libitum 1.5% CaCl2 as drinking fluid. The DOC animals were injected with a mineralocorticoid, deoxycorticosterone trimethyl-acetate, 25 mg/kg, s.c., once a week. Systolic blood pressure (BP) was measured once a week by the tail cuff method. During the nine-week study, the development of hypertension was enhanced in the DOC group, while in the calcium group a blood pressure-lowering effect was observed when compared to the controls. Calcium also abolished the hypertensive effect of DOC. The maximal velocity of calcium transport was higher in "inside-out"-vesicles of red blood cells as compared to controls in both calcium-supplemented groups. DOC treatment resulted in elevated sodium and potassium contents in tail artery tissue, while the effect of the combination of DOC + calcium was equal to controls. On the other hand, the tissue Na:K ratio was decreased in both tail artery wall and heart in the calcium group. Calcium treatment diminished the excretion of phosphate in both groups, while the plasma phosphate concentration was lowered in the calcium group. In mesenteric arterial rings, DOC impaired nitroprusside-induced relaxation, while the relaxation was enhanced compared to control in both the calcium and DOC + calcium groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of desoxycorticosterone acetate (DOCA) plus saline drinking on gentamicin-mediated nephropathy in rats

Studies were performed to examine the effect of desoxycorticosterone acetate (DOCA) treatment plus isotonic saline drinking on gentamicin (GM)-mediated nephropathy in rats. GM, 40 mg/kg/day, was subcutaneously injected for 13 days following a 5-week treatment with water drinking or DOCA (10 mg/kg/week) plus saline drinking. Twenty-four hours after the last injection of GM, renal blood flow (RBF) and Cin decreased to approximately 69% and 52% of the control values in water-drinking GM-treated rats, respectively, but was well maintained in DOCA plus saline-drinking GM-treated animals. There was no significant difference in morphologic tubular injury or the renal cortical GM content between GM-treated groups. Saline drinking alone (1% saline, 5 weeks) lessened neither GM-induced reduction in GFR nor tubular damage. Body weight loss occurred following GM injection in the water-drinking group but not in the DOCA plus saline-drinking and saline-drinking-alone groups. DOCA plus saline drinking significantly suppressed the plasma renin activity (PRA) but saline drinking alone did not. A significant inverse correlation was found between PRA and Cin in water-drinking GM-treated and untreated rats. The data suggest that the beneficial effect of DOCA plus saline drinking is associated with renin-angiotensin suppression rather than with the renal GM content or well-maintained hydration.

Treatment of canine hypoadrenocorticism with microcrystalline desoxycorticosterone pivalate

The efficacy of a microcrystalline desoxycorticosterone pivalate (DOCP) injection in the management of canine hypoadrenocorticism (CHAC) was investigated in 21 dogs. On day 0 dogs previously diagnosed with CHAC were given a physical examination and an injection (2.2 mg/kg) of DOCP. This was repeated on days 25 and 50. On day 75 of the study a final physical examination was performed and the success of therapy was evaluated. Blood samples were obtained for serum chemical analysis (Na+, K+, Cl-, BUN & creatinine) on day 0 and day 75. Body weight increased steadily from a mean (+/- SD) of 25.5 +/- 14.2 kg on day 0 to 27.1 +/- 14.8 kg on day 75. The mean serum biochemistry values on day 0 were outside normal limits for Na+ (139.3 +/- 9.2 mEq/l), K+ (5.4 +/- 0.9 mEq/l), and Na+/K+ ratio [(26.4 +/- 4.8)/l]. On day 75, after three injections of DOCP, the values for Na+ (148.2 +/- 5.2 mEq/l), K+ (4.9 +/- 0.6 mEq/l), and Na+/K+ [(30.8 +/- 4.2)/l] were normal and significantly (P less than 0.01) different from values on day 0. All dogs in the study did well on DOCP therapy. The few side effects observed resolved with concomitant administration of prednisolone and/or adjustment of the DOCP dose. All clients elected to continue DOCP therapy after the trial ended, and the dogs continue to do well.

Glucocorticoids in muscular dystrophy: beneficial effects of dexamethasone on avian myopathy

A corticosteroid with mixed glucocorticoid-mineralocorticoid actions was previously shown to improve neuromuscular function in muscular dystrophic chickens. The significance of that finding was recently underscored by reports that a mixed-action corticosteroid improved muscle function in Duchenne dystrophy patients, albeit at high doses. In the present study a pure glucocorticoid improved function and retarded muscle histopathology in the chicken, but a pure mineralocorticoid did not. These observations suggest that elucidation of mechanisms by which glucocorticoids beneficially affect dystrophic muscle could lead to development of more effective therapies.

Pathophysiology of deoxycorticosterone-secreting adrenal tumors

Two patients with hypermineralocorticoidism due to deoxycorticosterone (DOC) excess are described. The plasma 17-deoxysteroids of the zona fasciculata (ZF), namely DOC, corticosterone, 18-hydroxydeoxycorticosterone, and 18-hydroxycorticosterone, were elevated. Plasma androgen concentrations were normal, and plasma aldosterone and renin levels were low. One patient, who had benign adrenocortical adenoma, had normal plasma cortisol levels. The other patient, who had metastatic adrenocortical carcinoma, had low plasma cortisol, presumably due to elevated plasma corticosterone levels. While tumors producing only 17-deoxysteroids are rare, they have provided new insights into the regulation of 17-deoxysteroid secretion by the ZF. Presumptive suppression of a non-ACTH factor by adenoma-produced DOC transiently impaired the early postoperative responses to ACTH of the ZF 17-deoxysteroids of the contralateral adrenal. The dissociation of 17-deoxysteroids from cortisol in normal subjects given either dexamethasone or DOC acetate provides additional evidence for such a factor.

The effects of naloxone, dexamethasone, deoxycorticosterone and 17-hydroxyprogesterone on blood pressure responses of normal and adrenalectomized rats during hypovolaemic shock

The roles of, and interactions between, steroids and naloxone, an opioid antagonist, in the reversal of experimental hypotensive shock were studied in normal and adrenalectomized rats. In normal rats treated with dexamethasone or deoxycorticosterone or 17-hydroxyprogesterone the hypotension and shock caused by 1% bodyweight and 2% bodyweight haemorrhage could be substantially reversed by naloxone in a dose-related manner. In contrast, the reversal of hypotension by naloxone was markedly less in adrenalectomized rats. It is concluded that there is a co-ordinate release of pressor catecholamines and depressor enkephalins from adrenal glands in hypovolaemic shock. Eventually, the use of naloxone would be of much less value in the treatment of hypotension or shock in patients with Addison's disease.

Myopathy with tubular aggregates in a patient adrenalectomized for Cushing's syndrome

We report a patient with attacks of muscle weakness and mild myopathy with tubular aggregates, following bilateral adrenalectomy for adrenal Cushing's syndrome and replacement therapy with cortisone acetate and 9 alpha-fluorohydrocortisone. The replacement of 9 alpha-fluorohydrocortisone therapy by desoxycorticosterone acetate therapy led to the cessation of the attacks.

Hyperkalemic renal tubular acidosis: effect of furosemide in humans and in rats

Furosemide increases urinary acidification in control subjects and in certain patients with normokalemic or hypokalemic distal renal tubular acidosis (RTA). We studied the effect of furosemide in 14 patients with hyperkalemic distal RTA. In a group of patients with pure selective aldosterone deficiency, furosemide increased net acid and K excretion in a fashion indistinguishable from controls. This effect of furosemide was observed both in the presence and in the absence of acute mineralocorticoid administration. In another group of patients with hyperkalemic distal RTA, furosemide failed to decrease urine pH and to increase net acid excretion despite acute mineralocorticoid administration. Plasma aldosterone was variable in this group in that some patients had appropriate levels of aldosterone for the degree of hyperkalemia, whereas in the other patients the levels were low. The failure of these patients to respond to furosemide, despite pharmacologic doses of mineralocorticoid, suggests that these patients had a defect in H+ secretion other than that attributable to aldosterone deficiency alone. To gain insight into the mechanism whereby furosemide increases urinary acidification, we studied control and amiloride-treated rats pretreated with mineralocorticoid. In response to furosemide, control rats had a significantly lower urine pH and higher net acid and K excretion than that observed in amiloride-treated rats. These data suggest that furosemide increases H+ and K excretion, at least in part, by creating a favorable electric gradient for secretion of these ions since these effects were blunted in presence of inhibition of distal Na transport by amiloride.(ABSTRACT TRUNCATED AT 250 WORDS)

Replacement therapy against increased hydroxyurea toxicity in pituitary or adrenal ablated rats

The main rat adrenocortical hormone, corticosterone, the mineralocorticoid, 11-deoxycorticosterone (DCA) acetate given alone or together (2:1 ratio) twice daily at doses of 2-4 and 1-8 mg/kg, DCA enanthate given in a single injection of 20 mg/kg 0-3 days before the beginning of the experiments and a highly-concentrated injectable extract of the adrenal cortex (4 mg/kg as hydrocortisone twice a day) given by the intramuscular route, delay and partially protect against the increased toxicity following administration of the anticancer drug, hydroxyurea (800 mg/kg/day for 5 days) in adrenalectomized or hypophysectomized animals (80-100% lethality; in control non ablated rats 0-10% lethality). ACTH1-24 (tetracosactide) also proved effective in pituitary ablated rats. The best protection was afforded with the joint administration of corticosterone and DCA (2-4 and 1-2 mg/kg twice a day) or with corticosterone alone at doses (4 mg/kg twice a day) capable of giving plasma levels, six hours after administration on the third day, similar to those observed in non ablated rats receiving HYD in the morning. The adrenocortical hormones may replace a possible unique defense mechanism against drug toxicity, which is lacking in pituitary or adrenal ablated rats.

[Corticosteroid and ACTH levels in relation to the age and sex of children with congenital adrenocortical dysfunction]

The authors studied adrenal and corticotropic functions of the pituitary in 98 children with congenital adrenal dysfunction and in 41 normal children. The children's age ranged from 2 to 16 years. The bone age of the sick children ranged within 6 to 16 years. The content of hydrocortisone and ACTH in the sick children was shown to be within the age norm. This attests to the preservation in these children of the functional potentialities of the adrenals and pituitary. It was emphasized that high content of 11-deoxycortisol in untreated patients decreased in the course of treatment. Therefore, the level of 11-deoxycortisol may serve as criterion of the adequacy of the hormonal therapy received by the patients.

Combined effects of deoxycorticosterone and furaltadone on Escherichia coli infection in chickens

After low antibody-response line chickens were challenge exposed with Escherichia coli, 10% of the controls, 35% of those fed furaltadone , 37% of those fed deoxycorticosterone (DOC), and 92% of those fed furaltadone and DOC gained weight. Concentrations of DOC above or below the optimal concentration (40 mg/kg of feed) were less effective, eg, when 100 mg of DOC/kg of feed was fed with furaltadone , 45% of low antibody-response line birds gained weight as compared with 85% of the birds when furaltadone was fed alone. However, the optimal amount of DOC did vary among genetic stocks and with environment. Stocks of birds also differed in their response to the concentration of furaltadone and DOC. Socialization increased the effectiveness of furaltadone .

The various renal manifestations of the nephropathic form of cystinosis

Three phenotypic forms of cystinosis (nephropathic, juvenile-onset and benign adult forms) are well recognized. That not all infants and children have the classical nephropathic form with Fanconi's syndrome is illustrated by 2 of the 3 patients in this report. Case 1 had the typical nephropathic form with generalized proximal tubular dysfunction. In contrast, case 2 had transient features of Bartter's syndrome which preceded the manifestations of Fanconi's syndrome. Case 3 was more complex because he first presented with a syndrome of nephrogenic diabetes insipidus. He then developed features of Fanconi's syndrome as well as metabolic acidosis, hyponatremia and hyperkalemia. The failure of deoxycorticosteroid administration to elevate the serum concentration suggested, in retrospect, that he may also have had a form of acquired pseudohypoaldosteronism.

Congenital adrenal hypoplasia: two new cases

Two male adolescents with the X-linked form of congenital adrenal hypoplasia are described. Both grew slowly during childhood and adolescence and did not undergo pubertal development because of hypogonadotropic hypogonadism associated with the congenital adrenal hypoplasia. The severely delayed bone age in childhood is probably due to the adrenal androgen deficiency and suggests a role of these hormones in the prepubertal skeletal maturation. The failure of gonadotropin secretion still remains unexplained. A hypothalamic defect has been suggested, but further studies are necessary to clarify this hypothesis.

Combined treatment of severe hyponatremia due to inappropriate antidiuretic hormone secretion

A 6-year-old girl developed generalized seizures followed by coma, five days after surgical removal of a craniopharyngioma. Low serum sodium levels and low serum osmolality with inappropriately high urinary sodium output confirmed the diagnosis of inappropriate antidiuretic hormone (ADH) secretion. Treatment with 3% hypertonic saline solution and repeated doses of furosemide (1 mg/kg) improved her clinical condition; serum sodium levels, however, rose slowly and urinary excretion remained high. Deoxycorticosterone acetate (DOCA), 4 mg/sq m/day, was added to the above regimen. A striking clinical improvement was noted. Serum sodium levels returned to normal with a concomitant sharp decline in urinary sodium output. The clinical course of this patient demonstrates the efficacy of the addition of deoxycorticosterone acetate to hypertonic saline and furosemide in the treatment of severe, life-threatening hyponatremia due to the syndrome of inappropriate antidiuretic hormone secretion.

[Effect of hypokinesia on human nutritional status]

In three series of experiments of 120, 49 and 180 days in duration 36 test subjects were exposed to clinostatic and antiorthostatic hypokinesia. Human requirements for various nutrients were defined under hypokinetic conditions. It was demonstrated that during bed rest exercises together with adequate nutrition and after bed rest certain nutrients can serve as efficient countermeasures against metabolic changes.

[Hypotensive disorders during pregnancy as a cause of fetal hazard (author's transl)]

Hypotension during pregnancy is correlated with a perinatal mortality of 5.08%. Premature birth and growth retardation of the fetus in patients with hypotension are also often seen. The cause of hypotension is most likely a redistribution of the maternal blood volume in distended areas of the venous system and a low blood volume per se. The approach for the treatment of hypotension and the improvement of fetal well being may be the application of compounds which prevent the dilation of the venous vessels. A second approach could be the application of Desoxy-corticosteron-trimethyl-acetat (DCTA) to improve the maternal blood volume by retention of potassium. Both has to be examined in well defined investigations.

[Hypoparathyroidism and Addison's disease with moniliasis: report of two cases in childhood (author's transl)]

Two pediatric cases are described presenting a conjunction of Addison's disease and hypoparathyroidism. One of the two cases also exhibits moniliasis of the oral cavity (Whitaker's disease). A full report is given of the symptoms and of the laboratory analyses which have motivated the diagnosis, and of the endocrinological function tests which were intended to confirm the diagnosis. The clinical process and the therapeutic criteria adopted are subsequently reported. A discussion follows focusing on the possible causes of the coexistence of the immunological defect and of the endocrinous deficiencies which are typical of the syndrome. Pathogenetic priority is attributed to the immunological defect which induces a autoimmune lesion of the endocrinous glands concerned.

Renin-secreting tumor. Case report

Renin-secreting tumor, though rare, should be considered in assessing severe hyperreninemic, hypertensive patients. We studied an 18-year-old girl with hypokalemic hyperreninemic hyperaldosteronism. No angiographic lesion could be detected. The plasma renin activity (PRA) of the right/left renal vein was 7.3. With a presumptive diagnosis of renin-secreting tumor (RST), the patient was operated on, and a cortical nodule was found on the right lower pole. Partial nephrectomy was followed by a rapid fall in PRA (half-life, 33-44 min) and normalization of blood pressure (BP). At 3 1/2 months postoperatively, the patient showed normotension, normokalemia, normal aldosterone, and slightly elevated PRA unresponsive to postural changes and furosemide treatment. Tumoral PRA secretion responded to postural stimulus, spironolactone use, and nitroprusside-induced hypotension. Neither the high aldosterone excretion nor hyperreninemia decreased after 3 days of DOCA; this agrees with a previously reported case suggesting the usefulness of this test in the diagnosis of RST.

[Corticosteriod regulation of Na, K-ATPase and ion transport in diverse zones of rat kidney]

Effect of corticosteroids on the activity of transport Na, K-ATP-ase and on the content of Na and potassium ions in various zones of the kidneys in rats with removed adrenal glands was studied. Adrenalectomy diminished the activity of Na, K-ATP-ase and Na level considerably; the greatest changes were observed in the medullary and the papillary zones of the kidneys. Aldosterone administration increased the Na content in the medullary and papillary zones, but failed to influence the enzymatic activity. DOCA injections caused an increase in the enzymatic activity and normalized the Na content in the medullary and papillary zones of the kidneys. Hydrocortisone therapy restored the Na, K-ATP-ase activity in the cortical and the medullary zones. On the basis of the data obtained a conclusion was drawn that both minerals and glucocorticoids took part in the regulation of the transport processes through the membranes of the renal tubules, but influenced different areas of the nephron.

Neonatal salt loss in the hypertensive form of congenital adrenal hyperplasia

The 11 beta-hydroxylase deficiency (11OHD) form of congenital adrenal hyperplasia is diagnosed infrequently during the newborn period. A child presumed to have the 21-hydroxylase deficiency form of congenital adrenal hyperplasia was studied extensively as an infant. The diagnosis was based on ambiguous genitalia, elevated 17-ketosteroids, evidence of urinary 11-ketopregnanetriol, and salt loss. Severe hypertension was detected at 11 years, and 11 beta-hydroxylase deficiency was confirmed with elevated plasma 11-deoxycorticosterone and 11-deoxycortisol, low cortisol, and normalization of blood pressure following glucocorticoid replacement. Impaired aldosterone biosynthesis and salt loss were demonstrated during dexamethasone therapy. Salt loss during infancy does not distinguish between the 11 beta- and 21-hydroxylase deficiency forms of congenital adrenal hyperplasia.