Biomaterial Database

Aldosterone control in critically ill patients: ACTH, metoclopramide, and atrial natriuretic peptide. 1990

H Raff, and J W Findling

Endocrine Research Laboratory, St. Luke's Medical Center, Milwaukee, WI 53215.

A subset of critically ill patients has been described with low plasma aldosterone (Aldo) despite elevated plasma renin activity (PRA). In order to investigate possible mechanisms for these findings, the present study evaluated the Aldo response to exogenous ACTH or metoclopramide (MCP) in normal subjects and in patients admitted to the medical ICU. In addition, measurements of clinical status (Acute Physiology and Chronic Health Evaluation [APACHE II]) and atrial natriuretic peptide (ANP) were correlated with adrenal status. Critically ill patients were subdivided into normal (greater than 2) and subnormal (less than 2) Aldo-to-PRA ratio (Aldo/PRA). Patients with basal Aldo less than 70 ng/dl exhibited subnormal Aldo responses to ACTH, regardless of basal Aldo/PRA. However, normal responses to MCP were noted regardless of basal Aldo/PRA. No correlation between Aldo/PRA and APACHE II score or ANP levels was found. We conclude that critically ill patients with dissociated Aldo and renin can generate a normal Aldo response to MCP. This suggests that this syndrome is due to functional and potentially reversible dysfunction of the zona glomerulosa of the adrenal cortex.

UI	MeSH Term	Description	Entries
D008297	Male		Males
D008787	Metoclopramide	A dopamine D2 antagonist that is used as an antiemetic.	4-Amino-5-chloro-N-(2-(diethylamino)ethyl)-2-methoxybenzamide,Cerucal,Maxolon,Metaclopramide,Metoclopramide Dihydrochloride,Metoclopramide Hydrochloride,Metoclopramide Monohydrochloride,Metoclopramide Monohydrochloride, Monohydrate,Primperan,Reglan,Rimetin,Dihydrochloride, Metoclopramide,Hydrochloride, Metoclopramide,Monohydrochloride, Metoclopramide
D008875	Middle Aged	An adult aged 45 - 64 years.	Middle Age
D009320	Atrial Natriuretic Factor	A potent natriuretic and vasodilatory peptide or mixture of different-sized low molecular weight PEPTIDES derived from a common precursor and secreted mainly by the HEART ATRIUM. All these peptides share a sequence of about 20 AMINO ACIDS.	ANF,ANP,Atrial Natriuretic Peptide,Atrial Natriuretic Peptides,Atriopeptins,Auriculin,Natriuretic Peptides, Atrial,ANF (1-126),ANF (1-28),ANF (99-126),ANF Precursors,ANP (1-126),ANP (1-28),ANP Prohormone (99-126),ANP-(99-126),Atrial Natriuretic Factor (1-126),Atrial Natriuretic Factor (1-28),Atrial Natriuretic Factor (99-126),Atrial Natriuretic Factor Precursors,Atrial Natriuretic Factor Prohormone,Atrial Natriuretic Peptide (1-126),Atrial Pronatriodilatin,Atriopeptigen,Atriopeptin (1-28),Atriopeptin (99-126),Atriopeptin 126,Atriopeptin Prohormone (1-126),Cardiodilatin (99-126),Cardiodilatin Precursor,Cardionatrin I,Cardionatrin IV,Prepro-ANP,Prepro-CDD-ANF,Prepro-Cardiodilatin-Atrial Natriuretic Factor,Pro-ANF,ProANF,Proatrial Natriuretic Factor,Pronatriodilatin,alpha ANP,alpha-ANP Dimer,alpha-Atrial Natriuretic Peptide,beta-ANP,beta-Atrial Natriuretic Peptide,gamma ANP (99-126),gamma-Atrial Natriuretic Peptide,Natriuretic Peptide, Atrial,Peptide, Atrial Natriuretic,Peptides, Atrial Natriuretic,Prepro ANP,Prepro CDD ANF,Prepro Cardiodilatin Atrial Natriuretic Factor,Pro ANF,alpha ANP Dimer,alpha Atrial Natriuretic Peptide,beta ANP,beta Atrial Natriuretic Peptide,gamma Atrial Natriuretic Peptide
D003422	Critical Care	Health care provided to a critically ill patient during a medical emergency or crisis.	Intensive Care,Intensive Care, Surgical,Surgical Intensive Care,Care, Critical,Care, Intensive,Care, Surgical Intensive
D005260	Female		Females
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000324	Adrenocorticotropic Hormone	An anterior pituitary hormone that stimulates the ADRENAL CORTEX and its production of CORTICOSTEROIDS. ACTH is a 39-amino acid polypeptide of which the N-terminal 24-amino acid segment is identical in all species and contains the adrenocorticotrophic activity. Upon further tissue-specific processing, ACTH can yield ALPHA-MSH and corticotrophin-like intermediate lobe peptide (CLIP).	ACTH,Adrenocorticotropin,Corticotropin,1-39 ACTH,ACTH (1-39),Adrenocorticotrophic Hormone,Corticotrophin,Corticotrophin (1-39),Corticotropin (1-39),Hormone, Adrenocorticotrophic,Hormone, Adrenocorticotropic
D000328	Adult	A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available.	Adults
D000450	Aldosterone	A hormone secreted by the ADRENAL CORTEX that regulates electrolyte and water balance by increasing the renal retention of sodium and the excretion of potassium.	Aldosterone, (+-)-Isomer,Aldosterone, (11 beta,17 alpha)-Isomer