Nicholls M G, Espiner E A, Donald R A
J Lab Clin Med. 1976 Jun;87(6):1005-15.
Aldosterone responses to physiologic doses of known regulatory factors have been studied in 8 patients with treated congestive heart failure under standard conditions of electrolyte balance and controlled body posture. The response of plasma aldosterone, plasma renin activity (PRA), and in some instances angiotension II, to the brief (120 minute) intravenous administration of ACTH (1.25 mug beta1-24 ACTH in 60 minute and 5 mug in 60 minutes), angiotensin II (30 mug) and potassium (30 mEq.), and to 2 hours in the upright posture, was measured. The plasma aldosterone increase was greatest in response to ACTH (mean increment 20.8 ng. per 100 ml.) followed by that with upright posture (mean rise 17.1 ng. per 100 ml.), potassium (mean 6.7 ng. per 100 ml.) and angiotensin II (5.8 ng. per 100 ml.). PRA rose vigorously following 2 hours of upright posture and fell with angiotensin II infusion, but showed no definite change in response to potassium or ACTH. A diurnal pattern of PRA, angiotensin II, and plasma aldosterone on control days was observed in these patients, with higher prenoon levels falling to a nadir at midnight. The electrolyte and hormone response to administered aldosterone (75 mug over 2 hours) was also studied in the same patients. During aldosterone infusions, plasma aldosterone increased (increment range 36 to 110 ng. per 100 ml.), urine sodium excretion decreased, but no significant change in urine potassium excretion or in PRA was observed. It is concluded that small fluctuations in ACTH secretion, as well as change in body posture, produce marked effects on plasma aldosterone in patients with controlled congestive heart failure. Aldosterone responses to ACTH in these patients is similar to that observed in normal subjects.
在8例接受治疗的充血性心力衰竭患者中，在电解质平衡和控制身体姿势的标准条件下，研究了醛固酮对生理剂量已知调节因子的反应。测定了血浆醛固酮、血浆肾素活性（PRA），在某些情况下还测定了血管紧张素II，对促肾上腺皮质激素（ACTH）（60分钟内1.25微克β1 - 24 ACTH，60分钟内5微克）、血管紧张素II（30微克）和钾（30毫当量）进行短暂（120分钟）静脉注射，以及对直立姿势2小时的反应。血浆醛固酮升高对ACTH反应最大（平均增量为每100毫升20.8纳克），其次是直立姿势（平均升高每100毫升17.1纳克）、钾（平均每100毫升6.7纳克）和血管紧张素II（每100毫升5.8纳克）。直立姿势2小时后PRA剧烈升高，血管紧张素II输注后下降，但对钾或ACTH反应无明确变化。在这些患者中观察到对照日PRA、血管紧张素II和血浆醛固酮的昼夜模式，午前水平较高，午夜降至最低点。还在同一患者中研究了给予醛固酮（2小时内75微克）后的电解质和激素反应。在醛固酮输注期间，血浆醛固酮升高（增量范围为每100毫升36至110纳克），尿钠排泄减少，但尿钾排泄或PRA无显著变化。得出结论，在控制的充血性心力衰竭患者中，ACTH分泌的微小波动以及身体姿势的改变对血浆醛固酮有显著影响。这些患者对ACTH的醛固酮反应与正常受试者中观察到的值相似。
