Hyperaldosteronism in ketoacidosis and in poorly controlled non-ketotic diabetes

Quigley, Charmian A.; Pa, Sullivan; Gonggrijp, H.; Mj, Crowley; Jb, Ferriss; Dj, O'Sullivan

doi:10.1007/bf02940163

Cited by 6 publications

(3 citation statements)

References 12 publications

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“…This indicates that some patients with poorly controlled diabetes have mild secondary hyperaldosteronism, even in the absence of ketosis. 5 These findings illustrate the need to define the degree of metabolic control when studying the reninangiotensin system in diabetic patients. Plasma levels of angiotensin II close to or within the normal range may exert a pressor effect 14 and the higher plasma angiotensin II concentrations during poor metabolic control may contribute to higher blood pressure levels.…”

Section: The Renin-angiotensin System In Poorlymentioning

confidence: 94%

Diabetic control and the renin-angiotensin system, catecholamines, and blood pressure.

Ferriss¹,

O'Hare²,

Kelleher³

et al. 1985

Hypertension

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Diabetic ketoacldosis is usually associated with marked secondary hyperaldosteronism. Plasma levels of renin, angiotensin II, and aldosterone are markedly raised before treatment in most patients, with values falling rapidly toward normal as metabolic control is restored. In a few patients, mostly those with long-term complications of diabetes, plasma levels of renin, angiotensin II, and aldosterone before treatment remain within the normal range. In moderately hyperglycemic patients who have glycosuria but not ketonuria, plasma levels of all three substances are significantly higher than when control is improved. Occasionally, moderately hyperglycemic patients have mild secondary hyperaldosteronism. Improved metabolic control in such patients causes a rise in plasma volume and a rise in total exchangeable sodium, the latter to levels significantly above normal. Plasma catecholamine levels are markedly elevated in diabetic ketoacidosis, probably as a consequence of the ketoacidotic state. In nonketotic patients with moderate hyperglycemia, basal plasma norepinephrine levels are normal; catecholamine responses to exercise may be exaggerated, however. Epidemiological and animal studies suggest a relationship between blood pressure and blood glucose levels. There are few clinical studies of the effects of altering metabolic control of diabetes on blood pressure, and this is an important area for further study. (Hypertension 7 [Suppl II]: II-58-11-63, 1985) KEY WORDS • angiotensin II • aldosterone • plasma renin activity • plasma volume exchangeable sodium * norepinephrine * diabetes mellitus • hypertension

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Section: The Renin-angiotensin System In Poorlymentioning

confidence: 94%

Diabetic control and the renin-angiotensin system, catecholamines, and blood pressure.

Ferriss¹,

O'Hare²,

Kelleher³

et al. 1985

Hypertension

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“…It is known that the plasma concentration of aldosterone increases in dia¬ betic ketoacidosis (Christlieb, Assai, Katsilambros et al 1975;Scott, Espiner, Donald & Livesey, 1978;Quigley, Sullivan, Gonggrijp et al 1982). In addition, metabolic acidosis induced by infusions of ammonium chloride (Perez, Oster, Vaamonde & Katz, 1977;Schambelan & Sebastian, 1977;Perez, Oster, Katz & Vaamonde, 1979), hydrochloric acid (Perez et al 1979) or lactic acid (Perez, Kern, Oster & Vaamonde, 1980) stimulates aldosterone secretion, whereas meta¬ bolic alkalosis induced by infusion of sodium bicar¬ bonate (Julian, Galla, Guthrie & Kotchen, 1982) or by selective depletion of hydrochloric acid (Kassirer, Appleton, Chazan & Schwartz, 1967) suppresses aldo¬ sterone secretion.…”

Section: Introductionmentioning

confidence: 99%

Effect of hydrogen ion concentration on aldosterone secretion by isolated perfused canine adrenal glands

Radke¹,

Taylor²,

Schneider³

1986

Journal of Endocrinology

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The direct effects of changes in extracellular hydrogen ion (H+) concentration on aldosterone secretion under basal, angiotensin II- and potassium-stimulated conditions were studied in isolated, perfused canine adrenal glands. Changes in extracellular H+ concentration were induced by altering either the partial pressure of CO2 (pCO2) or the HCO3- concentration of the perfusate. Acid-base disturbances had a more pronounced effect on aldosterone secretion under stimulated than under basal conditions. Increasing H+ concentration enhanced angiotensin II- and potassium-stimulated aldosterone secretion, whereas decreasing H+ concentration markedly inhibited the secretory response to these stimuli. Because changes in H+ concentration, whether produced by varying extracellular pCO2 or extracellular HCO3- concentration, had similar effects on angiotensin II-stimulated aldosterone secretion, the data suggest that H+ concentration per se is the important determinant of the aldosterone secretory rate. Interestingly, during the immediate recovery period from pCO2-induced alkalosis under both angiotensin II- and potassium-stimulated conditions, aldosterone secretion always returned to a value significantly higher than that obtained just before alkalosis. The results of this study demonstrate that changes in extracellular H+ concentration influence the rate of aldosterone secretion, possibly via changes in intracellular pH, by a direct action on the canine adrenal gland. Therefore, when evaluating the control of aldosterone secretion, the acid-base status of the whole animal or of in-vitro adrenal tissue must be considered.

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“…For example, aldosterone levels in plasma increased during diabetic ketoacidosis (Christlieb et al 1975, Scott et al 1978, Quigley et al 1982, metabolic acidosis (Perez et al 1977, 1979, Schambelan & Sebastian 1977 and acute respiratory acidosis (Raff & Roarty 1988). Conversely, during metabolic alkalosis (Kassirer et al 1967, Julian et al 1982, plasma aldosterone concentration decreased.…”

Section: Introductionmentioning

confidence: 99%

Direct modulation of basal and angiotensin II-stimulated aldosterone secretion by hydrogen ions

Kramer

Robinson²,

Schneider³

et al. 2000

Journal of Endocrinology

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Hyperaldosteronism in ketoacidosis and in poorly controlled non-ketotic diabetes

Cited by 6 publications

References 12 publications

Diabetic control and the renin-angiotensin system, catecholamines, and blood pressure.

Diabetic control and the renin-angiotensin system, catecholamines, and blood pressure.

Effect of hydrogen ion concentration on aldosterone secretion by isolated perfused canine adrenal glands

Direct modulation of basal and angiotensin II-stimulated aldosterone secretion by hydrogen ions

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