Espiner E A, Donald R A
Clin Endocrinol (Oxf). 1980 Mar;12(3):277-86. doi: 10.1111/j.1365-2265.1980.tb02711.x.
The response of aldosterone to manipulations of the renin-angiotensin and hypothalamic-pituitary-adrenal systems has been studied in thirteen patients with primary aldosteronism due to a single adenoma (ten patients) or bilateral hyperplasia (three patients). The aldosterone response to dietary sodium restriction was small and variable, although urinary aldosterone excretion increased in nine out of twelve studies. The response of patients with hyperplasia could not be distinguished from those with adenoma. All patients were unresponsive to salt loading. By contrast, plasma aldosterone fell in all patients after overnight dexamethasone (1 mg) and increased after brief (1 h) physiological ACTH stimulation. During prolonged erect posture, plasma aldosterone increased in the three patients with hyperplasia and decreased or remained unchanged in patients with ademona. Changes in plasma renin activity were similar in both groups. These studies show that patients with primary aldosteronism, while largely unresponsive to manipulations of sodium balance, retain sensitivity to small and acute changes in ACTH. The different behaviour of patients with hyperplasia to prolonged erect posture cannot be explained by insensitivity to ACTH, but could be due to a relative increase in sensitivity to angiotensin.
对13例因单发腺瘤（10例）或双侧增生（3例）导致原发性醛固酮增多症的患者，研究了醛固酮对肾素 - 血管紧张素系统及下丘脑 - 垂体 - 肾上腺系统调控的反应。尽管在12项研究中有9项研究显示尿醛固酮排泄增加，但醛固酮对饮食中钠限制的反应较小且变化不定。增生患者的反应与腺瘤患者无法区分。所有患者对盐负荷均无反应。相比之下，所有患者在夜间服用地塞米松（1毫克）后血浆醛固酮下降，在短暂（1小时）生理性促肾上腺皮质激素刺激后升高。在长时间直立姿势期间，3例增生患者的血浆醛固酮升高，腺瘤患者的血浆醛固酮降低或保持不变。两组患者的血浆肾素活性变化相似。这些研究表明，原发性醛固酮增多症患者虽然对钠平衡的调控大多无反应，但对促肾上腺皮质激素的微小急性变化仍保持敏感性。增生患者对长时间直立姿势的不同反应不能用对促肾上腺皮质激素不敏感来解释，而可能是由于对血管紧张素的敏感性相对增加所致。
