Plasma 19-hydroxyandrostenedione is elevated in patients with high renin essential hypertension

OBJECTIVES

We have reported that 19-hydroxyandrostenedione (19-OH-A-dione) functions as an amplifier of the sodium-retaining and hypertensive action of aldosterone. We therefore measured 19-hydroxyandrostenedione in hypertensive patients.

PATIENTS AND MEASUREMENTS

We studied 53 normal male control subjects and 63 male patients with essential hypertension (48 patients with normal renin essential hypertension and 15 patients with high renin essential hypertension). Plasma 19-OH-A-dione levels were measured by RIA.

RESULTS

Plasma 19-OH-A-dione concentrations in control subjects and patients with normal and high renin essential hypertension were 115 +/- 46 (mean +/- SD), 112 +/- 49 and 201 +/- 79 pmol/l, respectively. Patients with high renin essential hypertension showed significantly higher 19-OH-A-dione concentrations than did control subjects. The evaluation of the correlation between plasma 19-OH-A-dione concentrations and plasma renin activity revealed that plasma 19-OH-A-dione concentrations in hypertensive subjects rose gradually with an increase in plasma renin activity. Therefore, a significant correlation was found between plasma renin activity and plasma 19-OH-A-dione (r = 0.586, P < 0.001). In contrast, in control subjects, no significant correlation was found between plasma renin activity and plasma 19-OH-A-dione (r = 0.059, P > 0.05).

CONCLUSIONS

The secretion of 19-OH-A-dione from the adrenal cortex is under the control of the renin-angiotensin system in hypertensives but not in normotensives.

Postmortem changes in blood tranylcypromine concentration: competing redistribution and degradation effects

Site and temporal changes in tranylcypromine (TCP) and lithium concentrations in blood were studied in a human poisoning case. Blood samples from peripheral vessels and six central vessels were obtained at 0, 6, 24, 48 and 72 h after starting the autopsy. Nine tissue samples were obtained on completion. TCP showed preferential concentration in liver (2.21 micrograms/g) and brainstem (2.46 micrograms/g). There was a moderate post mortem redistribution phenomenon with TCP concentrations lowest in peripheral blood (0.17 micrograms/ml) at 0 h and highest in central vessels at 24 h (0.52 micrograms/ml). At 72 h blood TCP concentrations fell below those at 0 time but the samples showed marked putrefactive changes. Control blood samples spiked with TCP and incubated for 48 h at 37 degrees C showed a 58% fall in drug concentration. By contrast with TCP, lithium, which has a small Vd (0.8 l/kg) and is chemically stable, did not show this pattern of change in blood concentration. The site and temporal differences in TCP concentration in blood can be explained by the competing effects of post mortem redistribution and drug degradation. Redistribution is an early post mortem phenomenon characterised by diffusion, along a concentration gradient, from drug reservoirs in solid organs into adjacent blood vessels. Drug degradation is a later phenomenon associated with putrefactive change.

[Studies on quantitative analysis of paraquat in whole blood--the evaluation of pre-treatments and analytical methods]

Paraquat and diquat are bipyridylium herbicide, which fatal poisoning cases have been reported in recent years. There are a number of methods for the pre-treatment and analysis of paraquat in body fluids and postmortem tissues. But the combined evaluation of these pre-treatments and analytical methods can be hardly found in literatures. We have carried out quantification of paraquat in whole blood with various combinations of pre-treatments and analytical methods, and evaluated those with respect to the sensitivity, recovery, time and cost. Non-treatment sample was a diluted solution of whole blood containing an aliquot of paraquat. The pre-treatments were achieved using two sorts of protein precipitants or Sep-Pak C18 cartridge. HPLC, second-derivative spectroscopy and ELISA were selected as analytical methods for quantification of paraquat. The most sensitive methods were combination of protein precipitants or Sep-Pak C18 and ELISA, but a combination of protein precipitant of sulfosalicylic acid and second-derivative spectroscopy was found to be more rapid and economical method. These methods would be applicable in forensic and clinical laboratories.

Postmortem toxico-kinetics of co-proxamol

Postmortem drug redistribution in suicidal poisonings by co-proxamol (dextropropoxyphene and paracetamol) has been studied. Analytical data for 8 tissue samples, including muscle and fat, up to 8 blood samples, and gastric and small bowel contents were obtained in 4 cases. Blood samples were taken from multiple sites at the start of autopsy and after 24 or 48 h. Concentrations of both drugs were site dependent with the lowest concentrations in peripheral blood. Paracetamol concentrations varied two to threefold and propoxyphene concentrations varied seven to tenfold. Pulmonary artery concentrations of paracetamol did not change significantly with time; propoxyphene concentrations typically increased twofold over 24 h and threefold over 48 h. Propoxyphene concentrations in the inferior vena cava increased unpredictably but occasionally significantly (up to sevenfold). For both drugs the most dramatic elevations of blood concentrations were seen in the aorta; in one case paracetamol rose to 1.9 g/l, 8 times the peripheral blood concentration and 4 times the liver level (454 mg/kg); propoxyphene rose to 191.5 mg/l, 55 times the peripheral blood concentration. This appears to reflect postmortem diffusion of unabsorbed drug from the gastric lumen. It is likely that markedly higher concentrations in the putrefactive fluid from the left pleural cavity as compared with the right also reflect diffusion from the stomach.

Postmortem absorption of drugs and ethanol from aspirated vomitus--an experimental model

Using human cadavers an experimental model was developed to simulate the agonal aspiration of drug- and alcohol-laden vomitus. By needle puncture, an acidified (N/20 HCl) 60-ml slurry of drugs (paracetamol 3.25 g, dextropropoxyphene 325 mg) and ethanol 3% w/v was introduced into the trachea. After 48 h undisturbed at room temperature, blood samples were obtained from ten sites. Ethanol and drug concentrations were highest in the pulmonary vessels in all five cases studied. Pulmonary vein mean ethanol was 58 mg% (range 13-130), paracetamol 969 mg/l (range 284-1934), propoxyphene 70 mg/l (range 11-168). Pulmonary artery mean ethanol was 53 mg% (range 10-98), paracetamol 476 mg/l (range 141-882), propoxyphene 29 mg/l (range 7.6-80). Ethanol and drug concentrations in aortic blood were higher than in the left heart and concentrations in the superior vena cava were higher than in the right heart, suggesting direct diffusion into these vessels rather than diffusion via the pulmonary and cardiac blood. Potential interpretive problems arising from this phenomenon can be avoided by using femoral vein blood for quantitative toxicological analysis.

Application of a computer assisted image analyzer to the assessment of area and number of sites of dental attrition and its use for age estimation

A simple method was devised to assess dental attrition in terms of its area and number of sites by using dental plaster casts and a computer assisted image analyser. The changes presented on the occlusal surfaces of teeth were investigated for age estimation using these criteria. The area of attrition on each tooth demonstrated a significant positive correlation with age, but a wide individual variation was observed in the values for each tooth. Therefore, this method was unsuitable for accurate age estimation of a single tooth. A strong negative correlation with age was observed in the number of sites of attrition. A multiple stepwise regression analysis using the variables 'attrition area' and 'attrition number' revealed multiple correlation coefficient values of 0.93. The quantitative assessment of both horizontal and vertical factors of dental attrition would be essential to improve the accuracy of this method.

Comparative studies on the usefulness of phosphate versus glycerin enema in preparation for colon examinations

Fifty of 100 persons who had undergone health screening received phosphate enema while the other 50 received glycerin enema prior to proctoscopy and barium enema, and their usefulness for preparation for colon examination was compared by a double-blind test. There was no significant difference in the degree of colonic cleansing achieved by proctoscopy and barium enema. In the subjects who received phosphate enema, the incidence of abdominal pain was less than that in those who received glycerin enema, while the effect of phosphate enema on defecation appeared later than that of glycerin enema, indicating prolonged stool retention in the subjects given phosphate enema. To study the safety of the two enemas, either phosphate enema, glycerin enema or physiological saline solution as a control was administered at 0.35 ml/animal in the rectum by 4-h closure of the anus in 10 male 7-week-old Wistar rats, and the rectal mucosa was observed for irritation macroscopically and histopathologically. Glycerin enema produced less irritation than phosphate enema diffusely in the entire area of the rectum, while phosphate enema produced more local irritation at the end of the rectum than glycerin enema. The differences in the extent of irritation and injury between phosphate and glycerin enemas were considered to be derived from differences in the pharmacologic actions of these drugs. If the extent of injury were included in the extent of irritation, the difference in irritation between phosphate and glycerin enemas would not be significant. As described above, no specific difference seem to exist in the usefulness of phosphate and glycerin enemas as preparation for colon examination.

Enhancement of the hypertensinogenic action of 19-hydroxyandrostenedione by aromatase inhibitor, delta 1-testololactone

To evaluate the enhancing effects of 1,2-dehydrotestololactone (delta 1-testololactone) on the hypertensinogenic action of 19-hydroxyandrostenedione (19-OH-A-dione), 1 mg 19-OH-A-dione, 10 mg delta 1-testololactone, or a combination of 1 mg 19-OH-A-dione and 10 mg delta 1-testololactone was injected into intact rats drinking water once a week for 4 weeks. The blood pressure of control rats and rats given 19-OH-A-dione, delta 1-testololactone, and a combination of 19-OH-A-dione and delta 1-testololactone in the fourth week was 130 +/- 2 (SE), 140 +/- 2, 128 +/- 6, and 152 +/- 5 mmHg, respectively. The blood pressure of rats given 19-OH-A-dione and a combination of 19-OH-A-dione and delta 1-testololactone was significantly higher than that of control rats. In addition, the blood pressure of rats given a combination of 19-OH-A-dione and delta 1-testololactone was significantly higher than that of rats given 19-OH-A-dione alone. As delta 1-testololactone itself did not show any hypertensinogenic action, it is considered to enhance the hypertensinogenic action of 19-OH-A-dione. Although plasma 19-OH-A-dione concentrations of control rats and rats given delta 1-testololactone were lower than the sensitivity of RIA, those of rats given 19-OH-A-dione and a combination of 19-OH-A-dione and delta 1-testololactone were 116 +/- 3 and 222 +/- 37 pg/ml, respectively. Plasma 19-OH-A-dione concentrations of rats given a combination of 19-OH-A-dione and delta 1-testololactone were significantly higher than those of rats given 19-OH-A-dione alone. Therefore, delta 1-testololactone is considered to enhance the action of 19-OH-A-dione by increasing plasma concentrations of 19-OH-A-dione. As delta 1-testololactone is an aromatase inhibitor, the inhibition of the conversion of circulating 19-OH-A-dione to estrogens in peripheral tissues might be the cause of the elevation of plasma 19-OH-A-dione concentrations. These results indicate that aromatose inhibitors enhance the hypertensinogenic action of 19-OH-A-dione by decreasing the degradation of 19-OH-A-dione.

Effect of prednisolone and salicylate on serum thyroglobulin level in patients with subacute thyroiditis

Twelve patients with subacute thyroiditis were divided into two groups and treated with prednisolone or salicylate. The initially elevated T4, T3, free T4 (FT4), free T3 (FT3) and erythrocyte sedimentation rate (ESR) were reduced during the early phase within about 4 weeks in both groups. The serum levels of thyroglobulin (Tg) were elevated in both groups treated with salicylate and prednisolone (252 +/- SD 117 ng/ml and 233 +/- SD 157 ng/ml, respectively) at initial examination. The serum level of Tg declined during the early phase with prednisolone treatment, and it reached normal values at the end of the early phase (17 +/- SD 15 ng/ml). With salicylate treatment, the decline of levels of Tg was delayed and it was elevated (80 +/- SD 34 ng/ml) despite normal levels of thyroid hormones and ESR at the end of early phase. The serum level of Tg at the end of the early phase of prednisolone treated was significantly lower than that of salicylate treatment (P less than 0.01). It is suggested that the effect of prednisolone on rapid decrease of Tg may be related to its inhibitory action of intrathyroid hydrolysis.

Pharmacokinetic profile of paraquat following intravenous administration to the rabbit

Pharmacokinetic studies of paraquat in rabbits were performed using [methyl-14C]-paraquat. Plasma concentration of paraquat following i.v. administration to the rabbit was fitted to a 3-exponential function of pharmacokinetic analysis. Distribution and elimination were discussed on the basis of the 3-compartment open model system, which has a central and two peripheral compartments. Computer simulations of paraquat levels in each compartment indicated that the slow-uptake peripheral compartment contained a greater amount of paraquat than the central or the fast-uptake peripheral compartment. On the basis of the present results of the computer simulations in company with tissue distributions of paraquat reported by the other investigators, it is likely that the slow-uptake peripheral compartment contains the lung. In cases of paraquat-induced renal failures, the paraquat levels of the slow-uptake peripheral compartment were remarkably higher than in cases of normal renal functions. Histology of the rabbit tissues 7 days after i.v. administration of paraquat revealed that marked changes were observed only in the kidney, suggesting some renal failures induced by paraquat. In spite of the high concentration of paraquat, which was presumed with the computer simulations in this study, the rabbit lung showed a remarkable resistance to paraquat toxicity. The histology studies suggested the complexities of paraquat toxicity to the rabbit. The lung toxicity in the rabbit would be caused by not only the paraquat concentration in the lung but also some biochemical parameters in the tissue related to the mechanisms of paraquat toxicity.

Effect of changes in thyroid state on metabolism of thyroxine by rat placenta

We studied the effect of the state of the thyroid on T4 monodeiodination in the rat placenta, and it was compared with those in the liver and kidney. The tissues, maternal serum, and amniotic fluid were obtained from pregnant rats. The tissues were homogenized in cold 50 mM Tris-HCl buffer, pH 7.5. The homogenate (1 mg protein) was incubated at 37 degrees C for 60 min with 1 microgram T4 in the presence of 5 mM DTT. The T3 and reverse T3 generated in the reaction mixture were extracted into cold ethanol and measured by RIAs. The conversion of T4 to reverse T3 in rat placenta was not significantly changed in MMI-induced hypothyroidism or T4 induced hyperthyroidism. On the other hand, conversion of T4 to T3 in the liver and kidney were changed in parallel with the thyroid state. The concentration of reverse T3 in the amniotic fluid was increased in accordance with the increase in the maternal serum T4 concentration. These results indicate that the placental T4 inner ring deiodination is not affected by the thyroid state, and that the change in the amniotic fluid reverse T3 concentration in this study is mainly dependent upon the change in maternal thyroid function.