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Aldosterone in the ovarian cycle of low renin hypertensive women.
No full textAldosterone in the Ovarian Cycle of Low Renin Hypertensive Women.
E. Fommei, S. Maffei, S. Ghione, A. Iervasi, C. Prontera.
Institute of Clinical Physiology, C.N.R., Pisa, Italy
"ish2006ab"
Abstract Registration [11693]
Objective. We previously reported an increase in plasma aldosterone levels during the luteal phase of the menstrual cycle in low renin hypertensive women. Recent in vitro observations indicate a stimulating effect of LH in aldosterone secreting adenomas (Amigh,2006). We here extend our observations and compare aldosterone changes with those of other hormonal parameters.
Design and Method. In fourteen low renin hypertensive women (range 33-53 yrs) plasma was taken at 08:30 hr a.m. and assayed for LH, FSH, 17beta-estradiol, progesterone, aldosterone (ALDO), PRA, cortisol (CORT) and BNP during one menstrual cycle (at days 7, 14, 21, 28).
Results. ALDO levels increased in the luteal phase (ANOVA p<0.005), clearly above the normal range in seven patients in the presence of low PRA. ALDO was related positively to PRA (<0.05), CORT(<0.05) and progesterone (<0.03) but negatively to estrogen (p<0.05) and BNP (p<0.005), the last two being directly related to each other (p<0.01).
Conclusions. Our results 1) confirm our previous observations that ALDO may abnormally increase during the menstrual cycle in low renin women; 2) support a possibile role of LH in ALDO stimulation, as recently suggested; 3) suggest that ALDO may increase in response to the natriuretic effect of progesterone whereas estrogen may be opposed by natriuretic peptide.
These findings should be considered when examining endocrine cardiovascular profile in women, particularly when screening for primary aldosteronism; in many hypertensive women the occurrence of hyperaldosteronism in the luteal phase could induce or aggravate pre-menstrual syndrome that might be relieved by aldosterone antagonist therapy
Aldosterone elevation during the luteal phase of the menstrual cycle may suggest primary aldosteronism in hypertensive women
No full textALDOSTERONE ELEVATION DURING LUTEAL PHASE OF THE MENSTRUAL CYCLE MAY SUGGEST PRIMARY ALDOSTERONISM IN HYPERTENSIVE WOMEN
Objective. Primary aldosteronism is a low-renin hypertensive condition which has being increasingly diagnosed in the last years. It is known that plasma aldosterone (ALDO) concentration may increase during the luteal phase of the menstrual cycle in normal women, particularly in the premenstrual syndrome. We here report some observations on the spontaneous changes of plasma ALDO during the menstrual cycle in hypertensive women.
Design and Method. Eleven reproductive-age essential hypertensive women (mean age 41, range 33-53 yrs) with known low renin values ( PRA<1 ng/ml/hr) under no antihypertensive treatment were studied four times during one menstrual cycle (at days 7, 14, 21, 28). Plasma samples were taken at 08:30 hr in the morning and assayed for LDH, FSH, 17 beta-estradiol, progesterone, aldosterone (ALDO) and PRA.
Results. The hormonal profile of each menstrual cycle was normal except for one patient who showed a non-ovulatory pattern. At day 7 normal ALDO and low PRA values were observed except for one patient with 1.2 ng/ml/hr PRA. During the luteal phase a significant increase in ALDO levels was observed (p<0.005, ANOVA test) with a resultant increase in ALDO/PRA ratio, as showed in the table. In particular, five patients showed ALDO levels above the normal range in the presence of low PRA values. A direct correlation was observed between ALDO and progesterone levels (p<0.02).
Table: PRA, ALDO and ALDO/PRA ratio (mean values and ranges).
Day 7 Day 14 Day 21 Day 28
PRA (ng/ml/hr) 0.34 (0.2-1.2) 0.68 (0.2-3.3) 0.59 (0.2-1.8) 0.46 (0.2-1.5)
ALDO (ng/dl) 8.8 (6.1-14.6) 13.1 (7.5-22.7) 17.9 (5.5-33.6) 16.4 (7.3-28.9)
ALDO/PRA 36 (5-63) 36 (2-66) 41 (7-92) 45 (16-70)
Conclusions. Our observations confirm that ALDO levels may change during the menstrual cycle; abnormally high ALDO and low PRA values may be observed during the luteal phase. These facts should be taken into account when screening for primary aldosteronism in hypertensive women of reproductive age
The influence of the ovarian cycle on the first-step laboratory screening for primary aldosteronism
No full textObjectives: to investigate the influence of the ovarian cycle on aldosterone in low renin hypertensive
women. Primary aldosteronism is in fact increasingly recognized as a cause of arterial hypertension and
aldosterone has been reported to vary in normal women during the ovarian cycle, usually increasing in the
luteal phase.
Methods: hormonal levels (LH, FSH, 17 beta-estradiol, progesterone, aldosterone, PRA) were measured at
weekly intervals during one menstrual cycle in 26 uncomplicated mild hypertensive women with known
low renin levels, after discontinuation of antihypertensive treatment. Statistical analysis was performed by
Friedman test, Bonferroni adjusted Wilcoxon test, Fisher exact-test or Chi-square test with continuity
correction, as appropriate.
Results: Aldosterone and PRA increased from the 7th day (follicular phase) to the 21st day (luteal phase)
from 11.2 to 17.8 ng/dL and from 0.23 to 0.35 ng/mL/hr, respectively, (p=0.004), with no significant
changes in aldosterone/PRA ratio (ARR) but with an increase in the number of patients with aldosterone
levels >15ng/dL (8/26 vs 19/25, p=0.018) or with an ARR >30 if combined with either a minimum PRA
value of 0.5 ng/ml/hr or an aldosterone level of >15 ng/dL (7/26 vs 16/25 and 7/26 vs 17/25 respectively,
p<0.05). Aldosterone was positively correlated with PRA and progesterone levels.
Conclusion: Hyperaldosteronism frequently occurs during the luteal phase of the ovarian cycle in low
renin hypertensive women (possibly linked to a progesterone effect); the ovarian cycle may thus be a
factor of variability in the performance of parameters and cut-off points commonly used in the first-step
laboratory screening for primary aldosteronism
Low renin hypertension and mineralocorticoid excess
No full textLow renin hypertension and mineralocorticoid excessP-639: Low renin hypertension and mineralocorticoid excess
Mineralocorticoid excess has being increasingly diagnosed in arterial hypertension and is known to be associated with a low renin condition; however it may escape diagnosis in the absence of overt hypokalemia and aldosteronism. Aim of the study was to assess in hypertensive patients the relationship between a low renin profile and adrenal abnormalities evaluated by CT and adrenocortical scintigraphy.
CT of the adrenal regions without contrast media injection was performed in 34 normokalemic hypertensive patients with low PRA levels(≤0,65 ng/ml/hr) and either high-normal or mildly elevated aldosterone levels (range 120–220 pg/ml) and in a series of eight hypertensive patients with comparable aldosterone but normal PRA levels (>0,65 ng/ml/hr). All patients had their antihypertensive treatment withdrawn and were under no salt restriction for at least one week at the time of laboratory examination. Iodomethyl-Nor-cholesterol adrenal scintigraphy under ACTH suppression by oral desamethasone was performed only in positive CT studies.
Adrenal CT was normal in the control population but showed either bilateral or unilateral abnormalities in 20 low renin patients: bilateral hyperplasia (n=8), unilateral hyperplasia (n=3), unilateral nodule (n=9). Scintigraphy showed hyperfunctioning glands in 11 out of 16 patients who underwent the examination (8 bilaterally, 3 unilaterally).
A low renin profile with inappropriately mantained aldosterone secretion in arterial hypertension may suggest adrenocortical hyperplasia or adenoma. A screening by means of adrenal CT is indicated, to be followed in the positive cases by adrenal scintigraphy or adrenal vein sampling. This workup could allow a correct diagnosis and tailored treatment
Serum thyroglobulin measurement in the follow-up of patients treated for differentiated thyroid cancer.
No full textDetermination of thyroglobulin (Tg) in serum represents a key element in the follow-up of patients treated for differentiated thyroid cancer (DTC). The sensitivity and the specificity of the assay strongly affects the clinical impact. Most of patients are disease-free after thyroidectomy and iodine radioablation; 15% of them show over time persistent or recurrent disease; of these, 5% dies due to worsening of disease. This implies that the follow-up procedures should have a high negative predictive value to reduce as possible the unnecessary diagnostic tools and a high positive predictive value to identify the few patients with persistent/recurrent disease. The recent international guidelines are based on thyroglobulin measurement after thyroid-stimulating hormone (TSH) stimulation. More recent studies suggest that follow up based on serial measurements of basal (i.e. unstimulated) Tg show a higher predictive value than the single measurement after stimulation. Large and multicenter studies are necessary to modify the current guidelines
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
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