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- Title
PREGNANCY INDUCED PSEUDO-PRIMARY HYPERALDOSTERONISM. NEW HEMODYNAMIC DATA.
- Authors
Gussi, I. L.; Jurcut, R.; Ionita, O.; Ginghina, C.; Ville, Y.
- Abstract
Introduction. Pseudo-primary hyperaldosteronism of pregnancy was previously reported by our group during correction in twin-to-twin transfusion syndrome (TTTS). Aim. Focus on plasma volume changes and renin-angiotensin (RAS) and aldosterone response in 45 TTTS patients requiring amnioreductions above 1000 mL for severe hydramnios. Methods. 45 patients necessitating placental surgery and amnioreduction >1000 mL for severe TTTS, under local anesthesia, as previously described. Assessment of plasma volume variations (%?PV) and simultaneous assays of aldosterone, renin, angiotensin II and ANP performed by standard kits prior to, 6 hours after and 12-24 hours after procedure. Statistical results expressed as median and interquartile ranges for non-parametric data, after correction of post-op levels with %?PV. Results. Depletion of 1600 mL (1000-3700) amniotic fluid (extravascular depletion) unexpectedly increased the intravascular plasma volume by 20.38% and dramatically changed the hormonal picture of primary hyperaldosteronism. Aldosterone decreased from a median of 730 pg/mL (T0) to 553 pg/mL (T6) to 515.9 pg/mL (T24). ANP increased from 8.95 pg/mL (T0) to 14.51 pg/mL (T6) to 19.9 pg/mL (T24) pg/ mL (ANOVA p=0.0036), while renin and angiotensin II stayed unchanged (ANOVA p=0.91). Conclusion. Depletion of extracellular fluid (amnioreduction) is indicated for the correction of hyperaldosteronism in pregnancies with severe hydramnios, to reduce to normal the aldosterone levels without the interference of the renin-angiotensin system, while natriuretic activity increases through ANP and, possibly, other less known natriuretic factors.
- Subjects
HYPERALDOSTERONISM; PREGNANCY; HEMODYNAMICS; FETOFETAL transfusion; ALDOSTERONE; RENIN-angiotensin system; BLOOD plasma; EXTRACELLULAR fluid
- Publication
Acta Endocrinologica (1841-0987), 2013, Vol 9, Issue 1, p63
- ISSN
1841-0987
- Publication type
Article
- DOI
10.4183/aeb.2013.63