John J. Harris

Hypertension, Oral Contraceptive Agents, and Conjugated Estrogens

36 of 325 women referred for plasma renin activity and aldosterone studies over a 4 year period were using oral contraceptives and 20 were taking conjugated estrogens. Available medical records indicated that 22 of the contraceptive users and 5 of the estrogen users were normotensive before medication. In patients taking the contraceptives plasma renin activity renin substrate and aldosterone excretion rate were moderately elevated. In 8 of 10 patients studied 3-6 weeks after medication was stopped plasma renin activity failed to have a normal increase in response to sodium restriction and standing. In 3 of 11 patients values were in the hyporesponsive range when they were tested 2-7 months later. 5 patients were studied who developed hypertension 3 months to 5 years after starting to take a conjugated estrogen. 4 became normotensive 1-7 months after they stopped taking the estrogen.(Authors modified)

Primary Aldosteronism Due to an Adrenal Carcinoma

Excerpt Primary aldosteronism is a syndrome characterized by hypokalemic alkalosis and hypertension. Benign adrenal cortical adenomas have been the cause of this syndrome in most of the patients re...

Estrogens and hypertension: effect of discontinuing estrogens on blood pressure, exchangeable sodium, and the renin-aldosterone system.

Studies were made on exchangeable sodium and on the renin-aldosterone system in 44 patients who gave the history of the development of hypertension after starting an estrogenic compound. Thirteen of 27 on conjugated estrogens (CE), three of three on diethylstilbestrol (DES), and 8 of 14 on an oral contraceptive (OCP) became normotensive on the average 3.6 months after the estrogen was discontinued. Seven of eight became hypertensive again on a repeat course of estrogens in three to six months. The average changes that had occurred after one month off the estrogenic compounds in the 44 patients (combined CE, DES, and OCP groups) were as follows: The Nae decreased −59.2 mEq; renin substrate decreased −64% but was still above normal limits in 79% after two to three months off the estrogens; renin activity decreased −25% and −17% respectively under normal sodium and low sodium conditions; urinary aldosterone decreased −18% on normal sodium conditions. The above changes were significant (p ± 0.05). Plasma aldosterone levels remained the same or increased slightly after the estrogens were discontinued. Thirteen patients elected to restart an estrogen to control their menopausal symptoms, after conclusion of the above observations. All could be kept within normal limits (blood pressure 129 ± 9/83 ± 5) without side effects on combined estrogen with spironolactone-diuretic administration.

URINARY CORTISOL EXCRETION AS A TEST OF ADRENAL CORTICAL FUNCTION.

Urinary Cortisol excretion rates have been measured before and during ACTH administration in normal subjects and in patients having or suspected of having adrenal cortical abnormalities. Patients with the following disorders were included in the study; Cushings syndrome, idiopathic hirsutism, Stein-Leventhal syndrome, exogenous obesity, hypopituitarism, and Addisons disease. Patients with Cushings syndrome had baseline Cortisol excretion rates 10 to 800 times the normal baseline values. This was true in some cases even though the baseline 17-ketogenic steroid excretion rates were normal or only slightly elevated. Those patients studied had a noticeably greater response than normal to ACTH, and in 2 patients the excessive excretion rate of Cortisol above their high baseline values continued for 1 or more days after intravenous ACTH was discontinued. The patients with adrenal-cortical adenomas had brisk increases in urinary Cortisol excretion rates during ACTH. Patients with “idiopathic” hirsutism had a greater than normal response to ACTH as measured by urinary Cortisol excretion rate. Two of 4 patients with Stein-Leventhal syndrome showed relatively little increase in urinary Cortisol excretion in response to ACTH. Ovarian resection in 1 patient had no influence on the responsiveness to ACTH; however, administration of estinyl estradiol for 2 weeks resulted in a normal increase in urinary Cortisol excretion in response to ACTH. Patients with exogenous obesity had normal baseline excretion rates of urinary Cortisol and the response to ACTH was normal.

Plasma Renin Activity in Hypertension.

Excerpt Two hundred eighty plasma renin activity (PRA) measurements were made in 100 patients with hypertension. Special attention was given to determining the usefulness of the PRA as a means of d...

Excessive fluid retention related to cellulose ingestion: studies on two patients.

Abstract Two female patients ages 35 and 31 years who had chief complaints of marked changes in weight with excess fluid retention were observed to remain edema-free (patient M.H.) for over 5 weeks on a low cellulose diet and (patient E.H.) for 9 weeks on a cellulose-free diet, with water intake unrestricted and sodium intake 90–160 mEq./day. The administration of short-chained methylcellulose (Cologel® 30 ml. three times a day) resulted in a 14-lb. weight gain in 48 hours in patient M.H. and an 8-lb. weight gain in 24 hours in patient E.H. The excess fluid disappeared by 72 hours after the last dose of Cologel. Fluid retention was demonstrated on two occasions in both patients at different phases of the menstrual cycle. At the peak of fluid retention, the patients had visual aberrations, mental cloudiness, and poor coordination of some skeletal muscle actions. During administration of Cologel there was sodium and water retention, a 5–8 mOsm/Kg. increase in serum osmolality, and a 25–75 per cent decrease in urinary aldosterone excretion rate. Fluid retention could be prevented in patient E.H. on a selective diet containing some cellulose by restricting sodium to 25 mEq./day, or by restricting water intake to 500 ml./day. Patient E.H. had a 5-fold greater than normal increase in plasma renin activity in response to sodium restriction. Aldosterone excretion rate increased from 8.9 to 330−450 μ g. 24 hours with 3–4 days of sodium restriction. Free water clearance in patient E.H. was 25–50 per cent of normal. Reinstitution of cellulose-containing foods in the diet resulted in a return of the problem of fluid retention.

Conjugated Estrogens (CE) and Oral Contraceptives (OCP) in Relation to Renin Activity and Blood Pressure.

Excerpt Twenty-one patients have been studied who developed hypertension (blood pressure 150/100) while taking oral contraceptives (OCP). Seventeen became normotensive (blood pressure 145/95) witho...

Urinary Corticoids by Gas Chromatography

The ideal tool in human steroid chemistry would be one that would separate a conglomerate of steroids and render a quantitative answer for each with a minimum of time and effort. We have not expected GLC to do this alone. Our aim has been to utilize preliminary solvent partition extraction; column, paper, or TLC; and GLC for isolation and quantitation of urinary steroids. Our approach has been to analyze the steroids as the free alcohols or ketones rather than as acetates or ethers. We recognize the advantage of derivatives, but we are also concerned about incomplete conversion of the steroids to esters and ethers. This paper is a short presentation of our experience with GLC of adrenal steroids.