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Value of direct measurement of active renin concentrations in congenital adrenal hyperplasia due to 21-hydroxylase deficiency

  • Endocrinology
  • Published:
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Abstract

In congenital adrenal hyperplasia (CAR) due to 21-hydroxylase deficiency, measurement of plasma renin activity (PRA) has been the method of choice in diagnosing salt loss and in monitoring adequacy of mineralocorticoid replacement therapy. Due to methodological problems in PRA determinations, direct immunoradiometric assays for the measurement of active renin concentration have been developed. We measured PRA and active renin concentrations simultaneously in 39 patients with CAH (30 salt-wasting, 9 simple virilizing) to evaluate the potential role of this new method in the management of this disease. PRA was determined with an enzymatic assay (sample volume: 2 × 1000 μl plasma), active renin concentration with a direct immunoradiometric assay (sample volume: 2 × 200 μl plasma or serum). We found a highly significant correlation between active renin and PRA in our patients (P < 0.001), as previously shown in healthy subjects. Active renin was as reliable as PRA to assess the quality of mineralocorticoid replacement.

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Abbreviations

CAH :

congenital adrenal hyperplasia

PRA :

plasma renin activity

SV :

simple-virilizing

SW :

salt-wasting

References

  1. Asbert M, Jiménez W, Gaya J, Ginés P, Arroyo V, Rivera F, Rodés J (1992) Assessment of the renin-angiotensin system in cirrhotic patients. Comparison between plasma renin activity and direct measurement of immunoreactive renin. J Hepatol 15: 179–183

    Google Scholar 

  2. Bangham DR, Robertson I, Robertson JIS, Robinson CJ, Tree M (1975) An international collaborative study of renin assay: establishment of the international reference preparation of human renin. Clin Sci Mol Med 48 [Suppl 2]: 135s-159s

    Google Scholar 

  3. Blazy I, Guillot F, Laborde K, Dechaux M (1989) Comparison of plasma renin and prorenin in healthy infants and children as determined with an enzymatic method and a new direct immunoradiometric assay. Scand J Clin Lab Invest 49: 413–418

    Google Scholar 

  4. Derkx FHM, Stuenkel C, Schalekamp MPA, Visser W, Huisveld IH, Schalekamp MADH (1986) Immunoreactive renin, prorenin, and enzymatically active renin in plasma during pregnancy and in women taking oral contraceptives. J Clin Endocrinol Metab 63:1008–1015

    Google Scholar 

  5. Dessi-Fulgheri P, Cocco F, Glorioso N, Bandiera F, Madeddu P, Rappelli A (1987) Immunoradiometric assay of active renin in human plasma: comparison with plasma renin activity. Clin Exp Hypertens [A] A9 (8, 9): 1383–1390

    Google Scholar 

  6. Dillon MJ, Ryness JM (1975) Plasma renin activity and aldosterone concentration in children. BMJ 4: 316–319

    Google Scholar 

  7. Dillon MJ, Gillin ME, Ryness JM, Swiet M de (1976) Plasma renin activity and aldosterone concentration in the human newborn. Arch Dis Child 51: 537–540

    Google Scholar 

  8. Fiselier TJW, Lijnen P, Monnens L, Munster P van, Jansen M, Peer P (1983) Levels of renin, angiotensin I and II, angiotensin converting enzyme and aldosterone in infancy and childhood. Eur J Pediatr 141: 3–7

    Google Scholar 

  9. Fischer TJW, Derkx F, Monnens L, Munster P van, Peer P, Schalekamp M (1984) The basal levels of active and inactive plasma renin concentration in infancy and childhood. Clin Sci 67: 383–387

    Google Scholar 

  10. Galen FX, Devaux C, Atlas S, Guyenne T, Menard J, Corvol P (1984) New monoclonal antibodies directed against human renin. Powerful tools for the investigation of the renin system. J Clin Invest 74: 723–735

    Google Scholar 

  11. Griffiths KD, Anderson JM, Rudd BT, Virdi NK, Holder G, Rayner PHW (1984) Plasma renin activity in the management of congenital adrenal hyperplasia. Arch Dis Child 59: 360–365

    Google Scholar 

  12. Holcombe JH, Keenan BS, Clayton GW, Kumar S (1981) Plasma 17α-hydroxyprogesterone and aldosterone concentrations in infants and children with congenital adrenal hyperplasia - the role of salt-losing hormones in salt wasting. J Pediatr 98: 573–575

    Google Scholar 

  13. Homer JM, Hintz RL, Luetscher JA (1979) The role of renin and angiotensin in salt-losing, 21-hydroxylasedeficient congenital adrenal hyperplasia. J Clin Endocrinol Metab 48: 776–783

    Google Scholar 

  14. Hsueh WA, Baxter JD (1991) Human prorenin. Hypertension 17: 469–479

    Google Scholar 

  15. Knorr D (1985) Das congenitale adrenogenitale Syndrom. Monatsschr Kinderheilkd 133: 327–335

    Google Scholar 

  16. Kuhnle U, Rösler A, Pareira JA, Gunzcler P, Levine LS, New MI (1983) The effects of long-term normalization of sodium balance on linear growth in disorders with aldosterone deficiency. Acta Endocrinol 102: 577–582

    Google Scholar 

  17. Limal JM, Rappaport R, Bayard F (1977) Plasma aldosterone, renin activity and 17-hydroxyprogesterone in salt-losing congenital adrenal hyperplasia. Response to ACTH in hydrocortisone treated patients and effect of 9-fluorocortisol. J Clin Endocrinol Metab 45: 551–559

    Google Scholar 

  18. Lutterotti N von, Catanzaro DF, Sealey JE, Laragh JH (1994) Renin is not synthesized by cardiac and extrarenal vascular tissues. A review of experimental evidence. Circulation 89: 458–470

    Google Scholar 

  19. Mellon SH, Miller WL (1989) Extraadrenal steroid 21-hydroxylation is not mediated by P450c21. J Clin Invest 84: 1497–1502

    Google Scholar 

  20. Menard J, Guyenne T-T, Corvol P, Pau B, Simon D, Roncucci R (1985) Direct immunometric assay of active renin in human plasma. J Hypertens 3[Suppl 3]: 8275–8278

    Google Scholar 

  21. Miller WL (1994) Clinical Review 54: genetics, diagnosis, and management of 21-hydroxylase deficiency. J Clin Endocrinol Metab 78: 241–246

    Google Scholar 

  22. New MI (1995) Steroid 21-hydroxylase deficiency (Congenital adrenal hyperplasia). Am J Med 98[Suppl 1A]2S-8S

    Google Scholar 

  23. Nicar MJ (1992) Specimen processing and renin activity in plasma. Clin Chem 38: 598

    Google Scholar 

  24. Ohyama K, Ohta M, Fujimoto M, Nakagomi Y, Yamori T, Kato K (1989) Plasma active renin concentration in children. Endocrinol Jpn 36: 605–610

    Google Scholar 

  25. Plouin PF, Cudek P, Arnal JF, Guyenne T-T, Corvol P (1990) Immunoradiometric assay of active renin versus determination of plasma renin activity in the clinical investigation of hypertension, congestive heart failure, and liver cirrhosis. Horm Res 34: 138–141

    Google Scholar 

  26. Rösler A, Levine LS, Schneider B, Novogroder M, New MI (1977) The interrelationship of sodium balance, plasma renin activity on ACTH in congenital adrenal hyperplasia. J Clin Endocrinol Metab 45: 500–512

    Google Scholar 

  27. Schaison G, Couzinet B, Gourmelen M, Elkik F, Bougneres P (1980) Angiotensin and adrenal steroidogenesis: study of 21-hydroxylase-deficient congenital adrenal hyperplasia. J Clin Endocrinol Metab 51: 1390–1394

    Google Scholar 

  28. Sealey JE (1991) Plasma renin activity and plasma prorenin assays. Clin Chem 37:1811–1819

    Google Scholar 

  29. Simon D, Hartmann DJ, Badouaille G, Calliot G, Guyenne T-T, Corvol P, Pau B, Marchand J (1992) Two-site direct immunoassay specific for active renin. Clin Chem 38: 1959–1962

    Google Scholar 

  30. Speiser PW, Agdere L, Ueshiba H, White PC, New MI (1991) Aldosterone synthesis in salt-wasting congenital adrenal hyperplasia with complete abscence of adrenal 21-hydroxylase. N Engl J Med 324: 145–149

    Google Scholar 

  31. White PC, New MI, Dupont B (1987) Congenital adrenal hyperplasia (Two parts). N Engl J Med 316: 1519–1524; 1580–1586

    Google Scholar 

  32. Zuo WM, Pratt RE, Heusser CH, Bews JPA, Gasparo MM de, Dzau VJ (1992) Characterization of a monoclonal antibody specific for human active renin. Hypertension 19: 249–254

    Google Scholar 

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Authors and Affiliations

  1. University Hospital for Children, University of Erlangen-Nürnberg, Loschgestrasse 15, D-91054, Erlangen, Germany

    C. Krüger, K. Höper, R. Weissörtel & H. G. Dörr

  2. Department of Internal Medicine I, University of Erlangen-Nürnberg, Loschgestrasse 15, D-91054, Erlangen, Germany

    J. Hensen

Authors
  1. C. Krüger
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  2. K. Höper
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  3. R. Weissörtel
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  4. J. Hensen
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  5. H. G. Dörr
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Krüger, C., Höper, K., Weissörtel, R. et al. Value of direct measurement of active renin concentrations in congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Eur J Pediatr 155, 858–861 (1996). https://doi.org/10.1007/BF02282834

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  • DOI: https://doi.org/10.1007/BF02282834

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