An easy diagnostic approach to primary aldosteronism.

The infusion of 40 mEq potassium (aspartate) in 250 ml isotonic 1-fructose at a rate of 20 mEq/h into 5 patients (34-56 years old) with aldosteronoma and 2 patients with bilateral primary aldosteronism consistently raised their mean arterial pressure by 15-20 mmHg. Their pressure values returned to the baseline levels 4-5 h after the infusion. In contrast, in controls (10 patients with idiopathic arterial hypertension, matched for age, sex, and magnitude of the untreated hypertension, and 7 patients with inactive adrenal nodules as incidental findings on upper abdomen ultrasound or computerized tomography) the same procedure caused negligible arterial pressure changes. The cause of the rise in blood pressure observed uniquely in patients with primary aldosteronism after infusion of potassium (aspartate) cannot be accounted for by an increase in plasma aldosterone, blood volume, or plasma angiotensin II. The cause of this response thus remains obscure; nonetheless, this simple procedure may prove useful in differentiating primary aldosteronism from idiopathic hypertension, in excluding the adrenal disorder, and in revealing even its mildest forms.

Frequency of pancreatographic changes in subjects with upper abdominal symptoms and its relationship with alcohol intake.

The aim of this study was to evaluate the endoscopic retrograde pancreatographic (ERP) findings in respect of alcohol intake. Two hundred eleven patients consecutively submitted to ERP for upper abdominal symptomatology, with suspected pancreatic disease (SPD; 79 patients) or without (NSPD; 132 subjects), were classified in 3 groups of different ethanol intake: 1 (0-40 g/day), 2 (41-80 g/day), 3 (more than 80 g/day). The following conclusions could be drawn: (1) the frequency of ERP changes increases with the increase of alcohol intake both in SPD (34.6-63.8%) and NSPD (8.2-29.8%); (2) the frequency of pancreatic cancer was not related to alcohol intake, but in NSPD it was about 2-fold that in SPD: 12/132 (9.1%) vs 4/79 (5.06%); (3) a pancreatic morphological assessment, by means of ERP or other imaging techniques, should be performed in every subject with upper abdominal pain of unknown origin both in alcoholics (for the high incidence of chronic pancreatitis) and in non-alcoholics (for the risk of pancreatic cancer, which approximates 10%).

Serum primary bile acids in chronic alcoholic pancreatitis.

Since cholestasis is a common, although poorly recognized, complication of chronic pancreatitis, and bile acids seem to be a sensitive index of cholestasis, fasting and post-prandial s-cholic and s-chenodeoxycholic acids were determined by radioimmunoassay in 48 chronic alcoholic pancreatitis patients (CP) and 22 healthy controls (C). Patients were grouped as follows: chronic pancreatitis with and without cholestasis; chronic pancreatitis operated on or not. A statistically significant increase in both CA and CDCA was observed in CP with cholestasis vis-a-vis C. In the CP without cholestasis and with normal biliary tract the average CA and CDCA values were also higher than in C, even though the difference was not statistically significant. No difference was observed between patients submitted or not submitted to pancreojejunostomy. The CA/CDCA ratio was increased in all CP subgroups, even in the patients without cholestasis, with significant difference only for some samples. Thus an increase in serum bile acids can be detected.