Mineralocorticoid hypertension due to a nasal spray containing 9 alpha-fluoroprednisolone

The American Journal of Medicine
F ManteroG Faglia

Abstract

The finding of hypokalemia and of low plasma renin activity (PRA) in a hypertensive patient suggests a diagnosis of primary hypermineralocorticoidism. Medications containing compounds with mineralocorticoid-like activity (licorice, carbenexolone) may also cause the same syndrome. Recently, we carried out detailed studies on 10 patients with severe hypertension and hypokalemic alkalosis, suppressed PRA and low aldosterone levels. Plasma levels of cortisol and ACTH were suppressed in most of the cases. Measurement of deoxycorticosterone and corticosterone (and in some patient of 18-hydroxydeoxycorticosterone and 18-hydroxycorticosterone) was not significantly higher than normal. Therapeutic trials of dexamethasone and aminoglutethimide were ineffective. In contrast, spironolactone and amiloride treatment resulted in substantial but incomplete amelioration of both hypertension and hypokalemia. All of the patients share a common history of chronic rhinitis and habitual use of large doses of nasal spray containing 9 alpha-fluoroprednisolone and vasoconstrictor agents. Withdrawal resulted in a complete remission of hypokalemia in one to two weeks in all patients. The hypertension and depressed levels of PRA, aldosterone and cortisol ...Continue Reading

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Citations

Jan 1, 1991·The Journal of Steroid Biochemistry and Molecular Biology·F ManteroN Sonino
Oct 1, 1992·The Journal of Steroid Biochemistry and Molecular Biology·F Mantero, M Boscaro
Jan 1, 1987·Clinical and Experimental Hypertension. Part A, Theory and Practice·C D SpenceB A Scoggins
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Aug 1, 1985·Journal of Endocrinological Investigation·R PedrinelliA Salvetti
Jun 23, 2006·Journal of Pediatric Endocrinology & Metabolism : JPEM·Wolfgang HoepffnerEberhard Keller
Jun 23, 2015·The Journal of Clinical Hypertension·Cesare CuspidiGiuseppe Mancia
Apr 1, 1989·Journal of Endocrinological Investigation·M ErricoM Grilli

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