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Plasma Renin Aktivität und Aldosteronverhalten bei kritisch kranken Patienten

Plasma renin activitiy and aldosterone responsiveness in critically III patients

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Summary

To investigate the influence of critical illness on plasma renin activity and aldosterone levels and to examine potential inhibitory effects of dopamine therapy on aldosterone responsiveness, we measured plasma renin activity, and potassium and creatinine in serum, as well as the responses of aldosterone, cortisol and prolactin levels to TRH 200 µg i.v. + Synacthen 0.25 mg i.v. in 63 unselected, critically ill patients (32 females, 31 males, aged 18–84 years). Of the patients 19 received dopamine treatment (3–13 µg/kg/min i.v.); 21 of the patients died in the further course of their disease. Plasma renin activity was increased in 66.7% of the patients and aldosterone levels were elevated in 90.5% of the patients. There were correlations (P<0.05) of lethality with plasma renin activity and cortisol levels and correlations (P<0.01) of aldosterone concentrations with plasma renin activity and cortisol levels. Whereas dopamine treatment had no inhibitory effect on aldosterone levels before and after stimulation, prolactin stimulation was decreased in dopamine-treated patients.

Thus, dopamine does not generally lose its potency of hormone inhibition in critically ill patients, but has no influence on the secondary aldosteronism developing regularly in the early phase of critical illness, which is apparently mainly due to the stimulatory effect of ACTH (or ACTH-related pituitary peptides) and is considered an epiphenomen of the stress mechanisms acting upon the patients in this condition.

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Abbreviations

ACTH:

Adrenocorticotropes Hormon

TRH:

Thyreotropin-Releasing Hormon

ZNS:

Zentrales Nervensystem

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Authors and Affiliations

  1. Zentrum der Inneren Medizin, Abteilung für Endokrinologie, Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt am Main

    E. Jungmann, E. Schifferdecker, A. Rümelin, P. -H. Althoff & K. Schöffling

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  1. E. Jungmann
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  2. E. Schifferdecker
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  3. A. Rümelin
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  4. P. -H. Althoff
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  5. K. Schöffling
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Jungmann, E., Schifferdecker, E., Rümelin, A. et al. Plasma Renin Aktivität und Aldosteronverhalten bei kritisch kranken Patienten. Klin Wochenschr 65, 87–91 (1987). https://doi.org/10.1007/BF01745482

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  • DOI: https://doi.org/10.1007/BF01745482

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