Adrenal gland response to adrenocorticotropic hormone is intact in patients with postural orthostatic tachycardia syndrome,Autonomic Neuroscience

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Adrenal gland response to adrenocorticotropic hormone is intact in patients with postural orthostatic tachycardia syndrome
Autonomic Neuroscience ( IF 3.2 ) Pub Date : 2023-06-24 , DOI: 10.1016/j.autneu.2023.103105
Jill K H Laurin ₁ , Oyebimbola A Oyewunmi ₁ , Emily M Garland ₂ , Alfredo Gamboa ₂ , Victor C Nwazue ₂ , Sachin Y Paranjape ₂ , Bonnie K Black ₂ , Luis E Okamoto ₂ , Cyndya A Shibao ₂ , Italo Biaggioni ₃ , David Robertson ₄ , André Diedrich ₅ , William D Dupont ₆ , Robert S Sheldon ₁ , Satish R Raj ₇

Affiliation

Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Vanderbilt Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
Vanderbilt Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA.
Vanderbilt Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.
Vanderbilt Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biomedical Engineering, School of Engineering, Vanderbilt University, Nashville, TN, USA.
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA.
Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Vanderbilt Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.

Background

Many patients with postural orthostatic tachycardia syndrome (POTS) are hypovolemic with plasma volume deficits of 10–30 %. Some also have low levels of aldosterone and diminished aldosterone-renin ratios despite elevations in angiotensin II, pointing to potential adrenal dysfunction. To assess adrenal gland responsiveness in POTS, we measured circulating levels of aldosterone and cortisol following adrenocorticotropin hormone (ACTH) stimulation.

Methods

While on a low Na⁺ diet (∼10 mEq/day), 8 female patients with POTS and 5 female healthy controls (HC) received a low dose (1 μg) ACTH bolus following a baseline blood sample. After 60 min, a high dose (249 μg) infusion of ACTH was administered to ensure maximal adrenal response. Venous aldosterone and cortisol levels were sampled every 30 min for 2 h.

Results

Aldosterone increased in both groups in response to ACTH but was not different between POTS vs. HC at 60 min (53.5 ng/dL [37.8–61.8 ng/dL] vs. 46.1 ng/dL [36.7–84.9 ng/dL]; P = 1.000) or maximally (56.4 ng/dL [49.2–67.1 ng/dL] vs. 49.5 ng/dL [39.1–82.8 ng/dL]; P = 0.524). Cortisol increased in both groups in response to ACTH but was not different in patients with POTS vs. HC at 60 min (39.9 μg/dL [36.1–47.7 μg/dL] vs. 39.3 μg/dL [35.4–46.6 μg/dL]; P = 0.724) or maximally (39.9 μg/dL [33.9–45.4 μg/dL] vs. 42.0 μg/dL [37.6–49.7 μg/dL]; P = 0.354).

Conclusions

ACTH appropriately increased the aldosterone and cortisol levels in patients with POTS. These findings suggest that the response of the adrenal cortex to hormonal stimulation is intact in patients with POTS.

中文翻译：

体位性心动过速综合征患者的肾上腺对促肾上腺皮质激素的反应完整

背景

许多患有体位性心动过速综合征 (POTS) 的患者存在低血容量，血浆容量不足 10-30%。尽管血管紧张素 II 升高，但有些患者的醛固酮水平较低，醛固酮-肾素比率降低，这表明潜在的肾上腺功能障碍。为了评估POTS 中的肾上腺反应性，我们测量了促肾上腺皮质激素 (ACTH) 刺激后醛固酮和皮质醇的循环水平。

方法

在采用低 Na ⁺饮食（~10 mEq/天）时，8 名 POTS 女性患者和 5 名女性健康对照 (HC) 在基线血样后接受低剂量 (1 μg) ACTH 推注。 60 分钟后，输注高剂量（249 μg）ACTH，以确保最大程度的肾上腺反应。每 30 分钟采样一次静脉醛固酮和皮质醇水平，持续 2 小时。

结果

两组对 ACTH 的反应均增加，但 60 分钟时 POTS 与 HC 之间没有差异（53.5 ng/dL [37.8–61.8 ng/dL] vs. 46.1 ng/dL [36.7–84.9 ng/dL]； P = 1.000）或最大（56.4 ng/dL [49.2–67.1 ng/dL] vs. 49.5 ng/dL [39.1–82.8 ng/dL]； P = 0.524）。两组患者对 ACTH 的反应均增加，但 60 分钟时 POTS 患者与 HC 患者的皮质醇没有差异（39.9 μg/dL [36.1–47.7 μg/dL] vs. 39.3 μg/dL [35.4–46.6 μg/dL] ； P = 0.724）或最大（39.9 μg/dL [33.9–45.4 μg/dL] vs. 42.0 μg/dL [37.6–49.7 μg/dL]； P = 0.354）。