ABSTRACT
OBJECTIVES: To review the childhood course of glucocorticoid-remediable aldosteronism (GRA) in order to provide management guidelines for hypertension in children. METHODS: Records for 20 children with GRA (aged 1 month to 18 years; 16 with hypertension) were retrospectively reviewed. RESULTS: Of the 16 children with GRA who developed hypertension, 50% had moderate-severe hypertension (blood pressure [BP] >99th centile for age and sex); 32% had mild hypertension (BP >95th and <99th centile), and 18% had borderline normal BP (BP >90th and <95th centile). Eight of 16 children with hypertension who received directed monotherapy (glucocorticoid suppression or aldosterone receptor/sodium epithelial channel antagonists) maintained BP below the 90th centile. Three additional subjects receiving a combination of directed therapies or a combination of directed therapies and nifedipine were unable to achieve BP control. At GRA diagnosis, 5 of 8 children were normokalemic, and plasma renin activity was suppressed in 5 of 5 subjects. CONCLUSIONS: Clinicians should have a high index of suspicion for GRA, especially in children with severe hypertension and a positive family history of early-onset hypertension and/or premature hemorrhagic stroke. Directed monotherapy is often successful in controlling BP in GRA.
Subject(s)
Glucocorticoids/therapeutic use , Hyperaldosteronism/complications , Hyperaldosteronism/drug therapy , Hypertension/complications , Adolescent , Child , Child, Preschool , Female , Glucocorticoids/administration & dosage , Humans , Hypertension/drug therapy , Infant , Male , Prevalence , Retrospective Studies , Severity of Illness Index , Surveys and Questionnaires , Treatment OutcomeABSTRACT
A history is presented of a couple suffering from long-standing infertility, which on laboratory investigation was found to be immunologic infertility, as expressed in the male partner. This case of male infertility was diagnosed by findings of sperm antibody in both the serum and the seminal plasma of the man, using both the Kibrick and the F-D sperm agglutination test methods. A new effort at treatment, by means of attempted immunosuppression, was proposed and applied, using corticosteroid medication. The special feature of this treatment involved a high dosage (96 mg. per day of methylprednisolone) for a short period (seven days). Laboratory studies revealed that the antibody levels, in both his serum and seminal plasma, did fall considerably. The wife became pregnant in the subsequent cycle. It is proposed that such diagnostic and treatment efforts be tried in other cases of male immunologic infertility.
Subject(s)
Immunosuppression Therapy , Infertility, Male/drug therapy , Methylprednisolone/therapeutic use , Antibodies , Coitus , Female , Humans , Infertility, Male/immunology , Male , Methods , Pregnancy , Semen/immunology , Spermatozoa/immunologyABSTRACT
A number of patients who have involuntary infertility show sperm antibodies in the blood serum, as detected by two quite different methods of spermagglutination. These techniques are the Kibrick method (gelatin agglutination test) and the F-D method (tube-slide agglutination test). By the former technique, the sera of 18% of women and 9% of men from infertile couples were found to be positive; by the latter technique, the sera of 15% of women and 5% of men were positive. Such cases are termed "immunologic infertility." In an effort to develop new methods for the treatment of infertility, two procedures were explored. One is a sperm washing insemination method in which fresh semen from a man with the antibody is centrifuged, resuspended in an albumin solution, and then used for insemination. The second is an immunosuppression method, using methylprednisolone at a dose of 96 mg/day for 7 days. A striking decrease in antibody level was seen in some cases, with ensuing pregnancy. The success rates for these methods have been of the order of 14% to 22%.
