Figure 415

Humoral changes in glucocorticoid-remediable aldosteronism with dexamethasone. A-E, Depicted are the changes in plasma cortisol (panel A), urinary aldosterone (panelB), plasma renin activity (PRA) (panel C), plasma aldosterone (panel D), and serum potassium (panel E) before and after dexamethasone administration in the patients in Figure 4-14. Note that before dexamethasone administration, serum cortisol was in the normal range and was markedly suppressed after treatment. Urinary aldosterone was completely normal and plasma aldosterone was elevated in only one patient before dexametha-sone administration. The diagnosis was made by demonstrating that the plasma aldosterone concentration failed to suppress normally after intravenous saline infusion (2 L/4 h) [6]. After dexamethasone administration, both plasma and urinary aldosterone levels decreased markedly (except for one occasion when it is suspected that the patient did not comply with dexamethasone therapy). PRA, which was markedly suppressed before treatment, increased with dexa-methasone. Note also that serum potassium levels were normal in two of the three patients before treatment with dexamethasone but increased with therapy in all three [5]. All of these changes reverted to control baseline values when dexamethasone therapy was discontinued.

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