Raff H, Findling J W
Endocrine Research Laboratory, St. Luke's Medical Center, Milwaukee, WI 53215.
Crit Care Med. 1990 Sep;18(9):915-20. doi: 10.1097/00003246-199009000-00003.
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.
有一部分重症患者被描述为血浆醛固酮（Aldo）水平低，而血浆肾素活性（PRA）升高。为了探究这些发现的可能机制，本研究评估了正常受试者以及入住内科重症监护病房（ICU）的患者对外源性促肾上腺皮质激素（ACTH）或甲氧氯普胺（MCP）的醛固酮反应。此外，还将临床状况（急性生理与慢性健康状况评估[APACHE II]）及心房利钠肽（ANP）的测量结果与肾上腺状态进行了关联分析。重症患者被分为醛固酮与肾素比值（Aldo/PRA）正常（大于2）和异常（小于2）两组。基础醛固酮水平低于70 ng/dl的患者，无论基础Aldo/PRA如何，对ACTH的醛固酮反应均异常。然而，无论基础Aldo/PRA如何，对MCP的反应均正常。未发现Aldo/PRA与APACHE II评分或ANP水平之间存在相关性。我们得出结论，醛固酮和肾素分离的重症患者对MCP可产生正常的醛固酮反应。这表明该综合征是由于肾上腺皮质球状带的功能性且可能可逆的功能障碍所致。
