Milton G. Crane

Essential Hypertension: New Concepts About Mechanisms

Abstract Patients with benign essential hypertension in the early uncomplicated stage show several deviations from normal in their renal and adrenal hormonal systems. Levels of plasma aldosterone a...

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.

Regression of Diabetic Neuropathy with Total Vegetarian (Vegan) Diet

This study reports alleviation of the sharp, burning pains characteristic of systemic distal polyneuropathy (SDPN) patients with adult-onset (Type II) diabetes mellitus (AODM).Twenty-one patients with known AODM and SDPN, average age 64, were trained in a low fat (10–15% of cats), high fiber, total vegetarian diet (TVD) of unrefined foods and conditioning exercise in a 25-day in-residence life-style program.Complete relief of the SDPN pain occurred in 17 of the 21 patients in 4 to 16 days. The numbness persisted, but had noticeably improved. Weight loss averaged 4-9 ± 2-6 kg during the 25 days. By the 14th day, the fasting blood glucose level averaged 35% lower for the 11 patients who were above 6-6 mmoll1, and the insulin needs had dropped in half the patients. Five no longer needed hypoglycemic agents. Also, serum triglyceride and total cholesterol had decreased by 25-0 ± 23% and 13 ± 15% respectively (p <0-01) in 2 weeks.Follow-up studies of 17 of the 21 patients for 1-4 years indicated that 71% had re...

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...

Vitamin B12 studies in total vegetarians (vegans).

The study aimed to assess the prevalence and rate of development of a low (below normal) serum B12 level in clinically well persons on a total vegetarian diet (TVD) with and without supplementation/fortification with B12.Serum B12 and red cell mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH) were measured in participants on a TVD for 12–340 months. Ability to absorb B12 orally was tested. In addition, urinary methylmalonic acid/creatinine ratio (UMMMCr) was measured in a subgroup of 27.In 47 of 78 adults the B12 level was below 200 pg ml-1, and the MCV was 94.2 ± 4.0. The other 31 adults had a B12 level of 200 or above, averaged 293 ± 85 pg ml-1 and an MCV of 92.6 ± 4.6. Eight children and 12 adults were on the same TVD, but were using B12-fortified soy milk instead of cows milk. Their B12 level ranged from 255 to 690 (average 417 pg ml-1) with a mean MCV of 88.8 ± 3.5 fl. The serum B12 level of seven of 16 adults with a low serum B12 who chewed a 100 μg tablet of B12 once a week for 6...

Surgical management of aldosterone-producing adrenal adenomas: A Review of 16 Patients

Summary Tabulation of the diagnostic evaluation and operative treatment of 16 patients with aldosteroneproducing adrenal adenomas is presented. The diagnosis of primary aldosteronism was confirmed in all patients by biochemical and radiologic studies. Selective venous sampling of adrenal vein aldosterone localized the adenoma in 14 patients and proved to be the single most helpful diagnostic procedure. Computed tomography was used recently to confirm the localization of these interesting lesions and may become the initial noninvasive diagnostic study. Confidence in the accuracy of preoperative localization has led to the choice of the posterior approach to the involved adrenal gland. Postoperative morbidity has been low regardless of the operative approach; however, subjective patient acceptance of posterior adrenalectomy suggests a more comfortable convalescence and a more rapid return to normal activity.

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...