Aldosterone responses to angiotensin I1 in anorexia nervosa Mizuno 0, Tamai H, Fujita M, Kobayashi N, Komaki G, Matsubayashi S, Nakagawa T. Aldosterone responses to angiotensin I1 in anorexia nervosa. Acta Psychiatr Scand 1992: 86: 450-454.
0.Mizuno, H. Tamai, M. Fujita,
Patients with anorexia nervosa (AN) tend to have renin-angiotensin-aldosterone (RAA) abnormalities caused by abnormal behaviors such as strict dieting, fasting, vigorous exercise, self-induced vomiting and abuse of laxatives and/or diuretics. Adrenal responsiveness to angiotensin I1 (A 11) was studied in 13 AN patients before and after therapy and in 6 normal sex- and age-matched controls: adrenal responses to postural change (1 h of walking following 1 h in a supine position) and to exogenous A I1 injection (A 11: 10 ng/kg/min intravenous infusion for 30 min). The 24-h urine sodium concentration was significantly lower in AN patients before therapy than after therapy. Plasma aldosterone secretory response to A I1 was significantly higher in AN patients before therapy in both postural change and exogenous A I1 injection tests compared with after therapy response and that of controls. On the other hand, there was no significant difference in adrenal response to postural change or to exogenous A I1 between AN patients after therapy and controls. In conclusion, increased A I1 sensitivity caused by chronic sodium deficiency in AN patients normalized over time as the patients recovered.
Department of Psychosomatic Medicine, Faculty of Medicine, Kyushu University, Fukuoka, Jaoan
Patients with anorexia nervosa (AN) tend to selfinduce vomiting and to abuse laxatives and/or diuretics. They maintain strict diets and fasts or overexercise (l), which leads to hypotension, abnormal plasma volume and abnormal electrolytes (2). These changes may be caused by increased activity of the renin-angiotensin-aldosterone (RAA) system, one of the major hormonal systems controlling blood pressure, plasma volume and electrolytes. Hypokalemia, hyponatremia or dehydration often exists in AN patients, resulting in increased plasma renin activity (PRA) and plasma aldosterone concentration (PAC). Although these findings may also be found in Bartter’s syndrome (3) and/or pseudo-Bartter’s syndrome (4), not all the characteristics of those syndromes are consistent with those of AN patients. We previously showed abnormalities in fluid and electrolyte metabolism in AN patients and discussed their management (5). In this study we further evaluate the RAA system and adrenal responsiveness to angiotensin I1 (A 11) in AN patients before and after treatment. Materials and methods Patients and protocol
Thirteen hospitalized Japanese women who met the criteria of AN in DSM-111-R (1) were studied. Ta450
N. Kobayashi, G. Komaki, S. Matsubayashi, T. Nakagawa
Key words: anorexia nervosa; angiotensin; aldosterone
Osamu Mizuno, M.D., Department of Psychosomatic Medicine, Faculty of Medicine, Kyushu University, 3-1 - 1 Maidashi, Higashi-ku, Fukuoka 8 12, Japan Accepted for publication August 14, 1992
ble 1 shows the clinical data of AN patients on admission and controls. Four AN patients were strict dieters with laxatives, 6 dieted without using laxatives and the remaining 3 self-induced vomiting. All were inpatients of our department and were treated by refeeding reinforced by cognitive-behavior therapy. After admission, patients maintained a normal sodium intake and were not allowed to self-induce vomiting or to use diuretic or cathartic drugs. They received no drugs during treatment. Within one month after admission and before the initiation of treatment with a daily food intake of >1200kcal, adrenal responsiveness to A I1 was assessed. Sodium and potassium intake were 160 and 80mEq/day, respectively. Adrenal responsiveness to A I1 was reassessed when the patients were successful in regaining weight to over 90% of the mean ideal body weight (IBW), as compared to normal populations of the same age, sex, and height as derived from tables of the Japanese Ministry of Health and Welfare (6) (3.7 0.44 months). All patients were initially amenorrhea1 and 2 restored to normal after therapy. The control subjects consisted of 6 normal female volunteers with no evidence or history of organic or mental illness. Adrenal responsiveness was assessed during the follicular phase of the menstrual cycle in
Aldosterone responses in AN Table 1. Clinical data of anorexia nervosa patients on admission and controls
Bod) weight
Bod) mdss index
Height
Ageoears)
(kg)
(4
20.8 1.7
36.6 3.7
156 1.4
20.5 0.2
51.8 2.7 P
0.Mizuno, H. Tamai, M. Fujita,
Patients with anorexia nervosa (AN) tend to have renin-angiotensin-aldosterone (RAA) abnormalities caused by abnormal behaviors such as strict dieting, fasting, vigorous exercise, self-induced vomiting and abuse of laxatives and/or diuretics. Adrenal responsiveness to angiotensin I1 (A 11) was studied in 13 AN patients before and after therapy and in 6 normal sex- and age-matched controls: adrenal responses to postural change (1 h of walking following 1 h in a supine position) and to exogenous A I1 injection (A 11: 10 ng/kg/min intravenous infusion for 30 min). The 24-h urine sodium concentration was significantly lower in AN patients before therapy than after therapy. Plasma aldosterone secretory response to A I1 was significantly higher in AN patients before therapy in both postural change and exogenous A I1 injection tests compared with after therapy response and that of controls. On the other hand, there was no significant difference in adrenal response to postural change or to exogenous A I1 between AN patients after therapy and controls. In conclusion, increased A I1 sensitivity caused by chronic sodium deficiency in AN patients normalized over time as the patients recovered.
Department of Psychosomatic Medicine, Faculty of Medicine, Kyushu University, Fukuoka, Jaoan
Patients with anorexia nervosa (AN) tend to selfinduce vomiting and to abuse laxatives and/or diuretics. They maintain strict diets and fasts or overexercise (l), which leads to hypotension, abnormal plasma volume and abnormal electrolytes (2). These changes may be caused by increased activity of the renin-angiotensin-aldosterone (RAA) system, one of the major hormonal systems controlling blood pressure, plasma volume and electrolytes. Hypokalemia, hyponatremia or dehydration often exists in AN patients, resulting in increased plasma renin activity (PRA) and plasma aldosterone concentration (PAC). Although these findings may also be found in Bartter’s syndrome (3) and/or pseudo-Bartter’s syndrome (4), not all the characteristics of those syndromes are consistent with those of AN patients. We previously showed abnormalities in fluid and electrolyte metabolism in AN patients and discussed their management (5). In this study we further evaluate the RAA system and adrenal responsiveness to angiotensin I1 (A 11) in AN patients before and after treatment. Materials and methods Patients and protocol
Thirteen hospitalized Japanese women who met the criteria of AN in DSM-111-R (1) were studied. Ta450
N. Kobayashi, G. Komaki, S. Matsubayashi, T. Nakagawa
Key words: anorexia nervosa; angiotensin; aldosterone
Osamu Mizuno, M.D., Department of Psychosomatic Medicine, Faculty of Medicine, Kyushu University, 3-1 - 1 Maidashi, Higashi-ku, Fukuoka 8 12, Japan Accepted for publication August 14, 1992
ble 1 shows the clinical data of AN patients on admission and controls. Four AN patients were strict dieters with laxatives, 6 dieted without using laxatives and the remaining 3 self-induced vomiting. All were inpatients of our department and were treated by refeeding reinforced by cognitive-behavior therapy. After admission, patients maintained a normal sodium intake and were not allowed to self-induce vomiting or to use diuretic or cathartic drugs. They received no drugs during treatment. Within one month after admission and before the initiation of treatment with a daily food intake of >1200kcal, adrenal responsiveness to A I1 was assessed. Sodium and potassium intake were 160 and 80mEq/day, respectively. Adrenal responsiveness to A I1 was reassessed when the patients were successful in regaining weight to over 90% of the mean ideal body weight (IBW), as compared to normal populations of the same age, sex, and height as derived from tables of the Japanese Ministry of Health and Welfare (6) (3.7 0.44 months). All patients were initially amenorrhea1 and 2 restored to normal after therapy. The control subjects consisted of 6 normal female volunteers with no evidence or history of organic or mental illness. Adrenal responsiveness was assessed during the follicular phase of the menstrual cycle in
Aldosterone responses in AN Table 1. Clinical data of anorexia nervosa patients on admission and controls
Bod) weight
Bod) mdss index
Height
Ageoears)
(kg)
(4
20.8 1.7
36.6 3.7
156 1.4
20.5 0.2
51.8 2.7 P
