[Excess mineralocorticoid syndrome secondary to nasal sprays containing 9 alpha-fluoroprednisolone]. 1987

V Foresti, and E Parisio, and G Ricci
U.S.S.L. n. 75/1, Milano.

Two patients with signs of hypermineralcorticism and suppressed plasma aldosterone levels are reported. For both patients the use of a nasal spray containing 9 alpha-fluoroprednisolone had been ascertained, the withdrawal of which was followed by the normalization of the clinical picture as well as by the normal reactivity of the renin-aldosterone system. The endocrine studies excluded the presence of enzymatic defects or the hypersecretion of minor mineralocorticoids. The tests with angiotensin II and ACTH did not result in an increase in aldosterone, which instead increased in a significant way after metoclopramide, even with still suppressed basal values. Since the PRA was normal at the time of the metoclopramide test, a persisting inhibition of the factors directly controlling aldosterone secretion by 9 alpha-fluoroprednisolone could be possibly envisaged. An interesting findings was the onset of severe hypokalemia, conditioning rhabdomyolysis with myoglobinuria in patient 1, after a treatment of few weeks only. Since the factitious use of mineral corticoids is not taken into account, the need of an accurate collection of case history in the differential diagnosis of hyporeninemic hypoaldosteronism with hypokalemia is stressed.

UI MeSH Term Description Entries
D006973 Hypertension Persistently high systemic arterial BLOOD PRESSURE. Based on multiple readings (BLOOD PRESSURE DETERMINATION), hypertension is currently defined as when SYSTOLIC PRESSURE is consistently greater than 140 mm Hg or when DIASTOLIC PRESSURE is consistently 90 mm Hg or more. Blood Pressure, High,Blood Pressures, High,High Blood Pressure,High Blood Pressures
D007008 Hypokalemia Abnormally low potassium concentration in the blood. It may result from potassium loss by renal secretion or by the gastrointestinal route, as by vomiting or diarrhea. It may be manifested clinically by neuromuscular disorders ranging from weakness to paralysis, by electrocardiographic abnormalities (depression of the T wave and elevation of the U wave), by renal disease, and by gastrointestinal disorders. (Dorland, 27th ed) Hypopotassemia,Hypokalemias,Hypopotassemias
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D008901 Mineralocorticoids A group of CORTICOSTEROIDS primarily associated with water and electrolyte balance. This is accomplished through the effect on ION TRANSPORT in renal tubules, resulting in retention of sodium and loss of potassium. Mineralocorticoid secretion is itself regulated by PLASMA VOLUME, serum potassium, and ANGIOTENSIN II. Mineralocorticoid,Mineralocorticoid Effect,Mineralocorticoid Effects,Effect, Mineralocorticoid,Effects, Mineralocorticoid
D012083 Renin A highly specific (Leu-Leu) endopeptidase that generates ANGIOTENSIN I from its precursor ANGIOTENSINOGEN, leading to a cascade of reactions which elevate BLOOD PRESSURE and increase sodium retention by the kidney in the RENIN-ANGIOTENSIN SYSTEM. The enzyme was formerly listed as EC 3.4.99.19. Angiotensin-Forming Enzyme,Angiotensinogenase,Big Renin,Cryorenin,Inactive Renin,Pre-Prorenin,Preprorenin,Prorenin,Angiotensin Forming Enzyme,Pre Prorenin,Renin, Big,Renin, Inactive
D005477 Fluprednisolone A synthetic glucocorticoid with anti-inflammatory properties.
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
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
D012220 Rhinitis Inflammation of the NASAL MUCOSA, the mucous membrane lining the NASAL CAVITIES. Nasal Catarrh,Catarrh, Nasal,Catarrhs, Nasal,Nasal Catarrhs,Rhinitides

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