Rhabdomyolysis and arterial hypertension caused by apparent excess of mineralocorticoids: a case report

We report the case of a 61-year-old man who was referred to our Institution because of severe hypokalemia, rhabdomyolysis and high blood pressure. Severe hypokalemia may lead to rhabdomyolysis. The plasma aldosterone concentrations were low and the plasma renin activity was suppressed. A diagnosis of apparent mineralocorticoid excess, attributable to licorice and grapefruit juice ingestion, was made. Glycyrrhizic acid and glycyrrhetinic acid, its hydrolytic product, in licorice extracts, and polyphenols, in grapefruit juice, can inhibit 11 beta-hydroxysteroid dehydrogenase type 2, the enzyme that converts cortisol to cortisone. Moreover, having suspended licorice and grapefruit juice ingestion, the plasma K+ levels and blood pressure values progressively and simultaneously returned to normal. We would like to stress the diagnostic weight of a careful history taking.     

Adiponectin and insulin sensitivity in primary aldosteronism

BACKGROUND: A high prevalence of metabolic syndrome has been reported in primary aldosteronism. Low levels of adiponectin, an adipokine with insulin-sensitizing properties, are considered a hallmark of the metabolic syndrome. We evaluated the relationship between adiponectin and insulin sensitivity in primary aldosteronism, with and without metabolic syndrome, compared with essential hypertension. METHODS: Forty patients with primary aldosteronism and 40 matched patients with low-renin essential hypertension (LREH) were studied. Patients with type 2 diabetes were excluded. Each group was divided into two subsets: one including patients with metabolic syndrome and one including patients without metabolic syndrome (ie, hypertension alone or associated with another component of the syndrome). RESULTS: Insulin resistance, defined by increased homeostasis model assessment (HOMA index), was higher in patients with primary aldosteronism than in those with LREH only in the absence of metabolic syndrome (P<.01), whereas in the subsets bearing the syndrome it was similar. Adiponectin levels were lower in primary aldosteronism than in patients with LREH (P<.01). Like HOMA index, the difference was maintained (P<.01) only in the subsets without metabolic syndrome. Adiponectin levels were inversely correlated with HOMA index and positively correlated with potassium levels both in primary aldosteronism (P<.001) or in LREH (P<.05) groups. CONCLUSIONS: Lower adiponectin as well as lower insulin sensitivity in primary aldosteronism compared with LREH seem to result from both direct (aldosterone excess) and indirect (hypokalemia) mechanisms. Therapeutic interventions aimed at correcting both potassium and adiponectin levels by specific antihypertensive agents might improve insulin sensitivity, providing better cardiovascular protection in primary aldosteronism.     

Aldosterone as an Independent Factor in Cerebrovascular Damage

Aldosterone is produced not only in the adrenal gland but also in other tissues, including the brain, where it plays an important role in the control of blood pressure and water and electrolyte homeostasis. Aldosterone has also been demonstrated to be a major factor in target organ damage independent of its effects on blood pressure. Herein we review the pathophysiology of aldosterone action in the brain and the clinical and experimental studies on the detrimental effects of aldosterone in the brain.     

Absence of gene mutations in a case of concomitant presence of carcinoid of the ampulla of vater pheochromocytoma and Von Recklinghausen disease

The rare association between Von Recklin-ghausen's disease (VRD) and tumours other than in central nervous system is well recognized. However, the concomitance of VRD, a carcinoid of the ampulla of Vater, and a pheochromocytoma has been described very rarely in literature. Furthermore, the possible role of the genes usually involved in multiple endocrine neoplasia (MEN) syndromes, in this association, is unclear. We report the case of a patient affected by VRD and extra-adrenal pheochromocytoma, operated on in the past for a carcinoid of the ampulla of Vater. To determine if genes involved in MEN syndromes might play a role in this particular triad, we investigated the presence of somatic or germline mutations in the RET proto-oncogene and menin gene by non isotopic polymerase chain reaction single stranded conformation polymorphism (PCR-SSCP) and heteroduplex gel electro-phoresis. The results demonstrated that no somatic or germline mutations in the MEN-1 and MEN-2 genes were involved in the pathogenesis of these tumours.     

Evaluation of Family Skills Training Programs to Prevent Alcohol and Drug Use: A Critical Review of the Field in Latin America

International Journal of Mental Health and Addiction - Family skills training programs (FSTPs) are the interventions of choice for the prevention of alcohol and drug use worldwide. However, the...     

Hypertension and Cognitive Function

Arterial hypertension, cerebrovascular disease, and dementia are related pathologies. This paper has reviewed comparatively the incidence of arterial hypertension and adult-onset dementia disorders. Hypertension is associated with cerebrovascular disease, which is in turn associated with dementia. It is the most important modifiable risk factor for stroke, which is a recognized cause of vascular dementia. In terms of pathophysiology of hypertensive brain damage, several hypotheses were developed, such as that vascular alterations induced by hypertension can induce lacunar or cortical infarcts and leucoaraiosis, that hypertension is responsible for cerebrovascular disease and acts into the contest of a pre-existing subclinic Alzheimer's disease (AD), that hypertension determines neurobiologic alterations (such as β-amyloid accumulation) resulting in neuropathologic damage, and that aging and cerebrovascular risk factors act together to cause cerebral capillary degeneration, mitochondrial disruption, reduced glucose oxidation, and reduced ATP synthesis. The consequence of these alterations are neuronal death and dementia. Macroscopic results of these mechanisms are the so-called white matter lesions (WML), the significance of which is analyzed. Increasing clinical evidence suggests a close relationship between the reduction of elevated blood pressure and countering of both vascular dementia and AD. Antihypertensive treatment probably influences cognitive performances and prevents cognitive function alterations and the development of dementia. It is therefore important to evaluate as soon as possible cognitive functions of hypertensive patients.     

Inositolphosphoceramide is not a substrate for the first steps in the biosynthesis of glycoinositolphospholipids in Trypanosoma cruzi

The major free glycoinositolphospholipids and protein-linked glycoinositolphospholipids in Trypanosoma cruzi contain ceramide as the lipid moiety. Ceramide was not found in mammalian glycosylphosphatidylinositol (GPI)-anchors. An alkylglycerol, either as a lyso species or acylated has been also found in T. cruzi anchors. However, unlike African trypanosomes, no diacylglycerol was detected in the GPI-anchors. Using a membrane preparation from epimastigotes upon labelling with UDP[3H]GlcNAc we identified [3H]GlcNAcPI as the first step of GPI biosynthesis. Both, alkylacylglycerol (major) and diacylglycerol are constituents of the lipid. Although inositolphosphoceramide is the main inositolphospholipid in epimastigotes, it does not incorporate GlcNAc. The de-N-acetylation step afforded [3H]GlcN(alkylacylglycerol)PI and we also detected the [3H]GlcN(lysoacyl)PI. A new metabolite, phosphoGlcN(lysoacyl)PI, which was formed on long incorporation times, was characterized by chemical and enzymatic degradations. Several [3H]-Man labelled GPI precursors were obtained by in vitro GDP[3H]-Man labelling in the presence of UDPGlcNAc. All of them were sensitive to PI-PLC and to saponification conditions, thus, supporting a glycerolipid structure.