Mineralocorticoid and metabolic response to metyrapone in normotensive children and children with dexamethasone-suppressible and primary hyperaldosteronism

Abstract

The effect of 5 to 9 days of metyrapone administration (400 mg/m2 every 4 h) on aldosterone, deoxycorticosterone, plasma renin activity, electrolyte balance, and blood pressure was investigated in 2 normotensive siblings (one of whom showed limited ACTH reserve), in 3 patients with hypertension and dexamethasone-suppressible hyperaldosteronism, and in a hypertensive patient with primary hyperaldosteronism due to bilateral adrenal hyperplasia. Results: 1. Plasma and urinary aldosterone levels were steadily suppressed by metyrapone in all cases, except in the oldest patient studied who had dexamethasonesuppressible hyperaldosteronism and in whom, after a few days, aldosterone gradually rose to normal levels. 2. Mild mineralocorticoid effect occurred only in the normal subject. In all other patients there was no apparent mineralocorticoid effect despite deoxycorticosterone hypersecretion. 3. There was no significant change in blood pressure with metyrapone administration in any patient.