In this paper, the author reported on the clinical evaluations of plasma renin activity (PRA) and plasma aldosterone concentration (PAC) by simultaneous measurement using radioimmunoassay techniques of the same plasma samples withdrawn from the patients with various endocrine and hypertensive diseases and from the patients with idiopathic edema.
1) In normal subjects (i.e. 6 healthy male adults), the values obtained were as follows : PRA was 3.95±2.03 (Mean±SEM) ng/ml/hour and PAC was 5.81±3.60 (M±SEM) ng/100ml in recumbent and supine positions. After furosemide-loading tests (i.e. standing upright and/ or walking for 2 hours after administration of furosemide 40 mg intravenously), PRA and PAC rose to 13.70±2.80 ng/ml/hour, and 17.05±5.48 ng/100 ml, respectively.
2) Of the 13 patients with essential hypertension, in most of the low renin group (4 cases) low values of PAC were obtained, and in normal renin group (9 cases) normal or exaggerated responses were observed after salt restriction and/or furosemide-loading test.
3) In the patients with primary aldosteronism (i.e. 9, preoperative, and 7, postoperative), the simultaneous measurement of PRA and PAC was useful for preoperative clinical diagnosis, for determination of localization of adrenocortical adenoma, for the differential diagnosis from low renin essential hypertension, and for the postoperative and pathophysiologic understanding in the fields of renin-angiotensin-aldosterone axis.
4) In the 4 patients with Cushing's syndrome, a case of adrenal carcinoma disclosed a dissociation of PRA and PAC values (extremely high PRA and low PAC), and the other 3 cases of adrenal hyperplasia showed normal values of PRA and PAC.
5) Though 4 patients with Addison's disease showed high PRA and extremely low PAC, 4 patients with hypopituitarism including 3 cases of Sheehan's syndrome showed normal PRA and low or lower limits of normal PAC, and additional 2 cases of this disorder associated with cerebral hypernatremia showed extremely high PRA levels.
6) In 5 patients with acromegaly, 2 cases of the hypertensive group showed suppressed responses of PRA and PAC after furosemide-loading tests, and 3 cases of the normotensive group showed normal responses after the same loading tests.
7) In 8 patients with anorexia nervosa, 3 cases showed low PRAs, 2 cases showed high PRAs, and several of them disclosed a dissociation of PRA and PAC, but the pathogenesis or implication was not clarified.
8) A case of pheochromocytoma associated with neurofibromatosis showed high PRA and PAC levels, and exaggerated responses for furosemide loading, preoperatively; but both parameters recovered to normal, postoperatively.
In each case of hyperthyroidism and idiopathic edema, high PRA and normal PAC were observed.
9) In a case of Prader-Labhart-Willi's syndrome with glomerulosclerosis and of Kimmelstiel-Wilson's syndrome, PRA and PAC values were within normal range.
10) In a case of Bartter's syndrome manifesting secondary aldosteronism, and of extrarenal ectopic renin-secreting orbital and brain tumor manifesting primary reninism, both patients disclosed specific pathophysiologic states of dominant high PRAs rather than hyperaldosteronism.
11) Inconclusion, the simultaneous measurement and clinical evaluation of PRA and PAC were significantly evaluated in : (1) a test for stimulation of renin release, (2) a screening test for secondary or symptomatic hypertension, (3) the differential diagnosis between low renin essential hypertension and primary aldosteronism, (4) the determination of localization of adrenal tumor by selective adrenal vein sampling in primary aldosteronism, and (5) the understanding of pathophysiology in secondary aldosteronism.
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