Hegstad R, Brown R D, Jiang N S, Kao P, Weinshilboum R M, Strong C, Wisgerhof M
Am J Med. 1983 Mar;74(3):442-8. doi: 10.1016/0002-9343(83)90971-3.
We measured urinary and plasma aldosterone in normal subjects, aged 20 to 59 years, during a period of unrestricted sodium intake and after sodium depletion, using furosemide or a 20 meq sodium diet. Before and after sodium depletion, the mean and the upper limit of the range of urinary aldosterone excretion were considerably lower in subjects over 50 years compared with subjects under 30 years. Aging had no effect on plasma aldosterone concentration when the subjects were on an unrestricted sodium diet and blood was sampled while they were recumbent. In contrast, when the subjects were upright, both before and after sodium depletion, the mean and the upper limit of the range of plasma aldosterone concentration were lower in the subjects over 50 years compared with those under 30 years. The metabolic clearance of aldosterone was the same in the younger and the older subjects. Of eight patients over 40 years of age with aldosterone-producing adenoma, four had normal aldosterone excretion rates when the normal range was not age adjusted, but with age adjustment, all of the patients had clearly elevated excretion rates. Similarly, six of seven patients over 40 years of age had normal upright plasma aldosterone concentrations if the normal range of plasma aldosterone concentration was not age adjusted. We conclude that aldosterone secretion declines with advancing age. The effect of age on aldosterone secretion is an important consideration when evaluating older hypertensive patients for primary aldosteronism.
我们对年龄在20至59岁的正常受试者，在钠摄入不受限制期间以及钠耗竭后，使用速尿或20毫当量钠饮食的情况下，测量了尿醛固酮和血浆醛固酮。在钠耗竭前后，50岁以上受试者的尿醛固酮排泄均值及范围上限显著低于30岁以下受试者。当受试者钠摄入不受限制且卧位采血时，年龄对血浆醛固酮浓度无影响。相比之下，当受试者站立时，在钠耗竭前后，50岁以上受试者的血浆醛固酮浓度均值及范围上限均低于30岁以下受试者。年轻和年长受试者的醛固酮代谢清除率相同。在8例40岁以上患有醛固酮分泌腺瘤的患者中，当正常范围未根据年龄调整时，4例患者的醛固酮排泄率正常，但经年龄调整后，所有患者的排泄率均明显升高。同样，7例40岁以上患者中，若血浆醛固酮浓度正常范围未根据年龄调整，6例患者站立时血浆醛固酮浓度正常。我们得出结论，醛固酮分泌随年龄增长而下降。在评估老年高血压患者是否患有原发性醛固酮增多症时，年龄对醛固酮分泌的影响是一个重要的考虑因素。
