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Aldosterone metabolism after prolonged ACTH administration in juvenile hypertension


The effect of a 5-day continuous ACTH infusion (Acthar, 40 U/24h) on aldosterone metabolism was evaluated in 3 hypertensive children with hyperaldosteronism, 2 children with essential hypertension, and 1 normotensive control. Plasma aldosterone concentration(PA) and urinary excretion of aldosterone pH1 conjugate(pH1A), tetrahydroaldosterone(THA) and free aldosterone (FA) were measured by radioimmunoassay. In the patients with hyperaldosteronism, PA rose 3-fold and the 3 urinary metabolites showed a sustained 5-fold increase throughout the ACTH test. In the other children, PA and urinary aldosterone. metabolites rose 2-4 fold on the 1st day of ACTH administration, but decreased on the 4th and 5th day. pH1A fell more rapidly than either THA or FA. Consequently, the THA/pH1A ratio rose from 3.0 to 8.6 during the 5-day ACTH test. Conclusions: 1)prolonged ACTH administration induces a shift in the excretory pattern of the aldosterone metabolites leading to increased excretion of THA and FA; 2)pH1A alone is not an adequate index of aldosterone secretion in prolonged ACTH administration; 3) in hyperaldosteronism, ACTH produces an unusual sustained increase of all aldosterone metabolites.

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Rauh, W., Levine, L., Forster, E. et al. Aldosterone metabolism after prolonged ACTH administration in juvenile hypertension. Pediatr Res 12, 156 (1978).

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