1.Secondary Hyperkalemic Paralysis Mimicking Demyelinating Sensorimotor Polyneuropathy.
Tae Eun KIM ; Yeo Jeong KANG ; Jeong Ho PARK ; Sun Ah PARK ; Ki Bum SUNG ; Tae Kyeong LEE
Journal of the Korean Neurological Association 2012;30(4):355-357
No abstract available.
Hyperkalemia
;
Paralysis
;
Polyneuropathies
;
Spironolactone
2.Blood pressure-lowering efficacy of Spironolactone in patients with Resistant Hypertension: A meta-analysis
Mithi Kalayaan Zamora ; Jeremiah Vallente ; Raymond Oliva
Philippine Journal of Internal Medicine 2018;56(2):89-95
Introduction:
Resistant hypertension (RH) is defined as a blood pressure (BP) reading that remains above goal despite concurrent use of three optimally dosed antihypertensives of different classes, including a diuretic. Spironolactone, a mineralocorticoid receptor antagonist, has shown significant benefit in reduction of BP in recent trials and is used empirically as an add-on therapy for RH. The researchers’ objective is to evaluate the BP-lowering efficacy of spironolactone in patients with resistant hypertension.
Methods:
A meta-analysis was performed on randomized controlled trials (RCTs) comparing office or home BP reduction using spironolactone with placebo or an alternative drug regimen on top of standard-triple drug therapy among patients with RH. The study was conducted in reference to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).
Results:
Five RCTs were included comprising a total of 662 patients. Three of these studies were found to have low risk of bias while two had unclear risk of bias. Compared to placebo, the addition of spironolactone significantly decreased office systolic BP (weighted mean difference [WMD]= -16.33, 95% confidence interval [CI]=-24.68 to -7.97, P=0.0001) and office diastolic BP (WMD=-6.12, 95% CI= -9.35 to -2.89, P=0.0002). Compared to an alternative drug regimen, additional spironolactone resulted in a significantly greater reduction in office systolic BP (WMD=-4.58mmHg, 95% CI=-7.19, -1.97, P= 0.0006) and home systolic BP (WMD= -4.33, 95% CI= 5.55, -3.12, P< 0.00001); while the addition of spironolactone had no significant difference compared to an alternative drug regimen in reducing office diastolic BP (WMD=-3.35, 95% CI=-12.08 to +5.38, P=0.45) and home diastolic BP (WMD= 0.00, 95 % CI=-0.73 to 0.73, P=1.0).
Conclusion
Spironolactone, when added to triple-drug anti-hypertensive therapy, showed significant reduction of systolic office and home BP. It should be considered as the add-on medication of choice for BP reduction in patients with RH.
Antihypertensive Agents
;
Spironolactone
;
Blood Pressure
3.The Usefulness of Monitoring of Transtubular Potassium Gradient and Spot Urine Na/K Ratio in the management of Cirrhotic Ascites.
Young Seok LIM ; Hyo Suk LEE ; Jung Hwan YOON ; Jin Suk HAN ; Chung Yong KIM
The Korean Journal of Hepatology 2000;6(1):12-23
BACKGROUND/AIMS: Transtubular potassium gradient(TTKG) is known as the most accurate indicator of aldosterone activity. TTKG may be used to monitor the effectiveness of aldosterone antagonist which is prescribed generally for the management of cirrhotic ascites. Spot urine [Na]/[K] ratio may also be used for the same purpose. METHODS: After measuring TTKG, spot urine [Na]/[K] ratio, and plasma aldosterone concentration in each of the 23 patients all who had cirrhotic ascites, 100 mg of spiron-olactone was prescribed to be taken daily for 5 days. When no diuretic response occurred and TTKG was more than 3.5 at the end of 5 days, the dose of spironolactone was increased by 100 mg/day at the interval of 5 days until TTKG decreased to below 3.5. Furosemide was added to the non-responders if their TTKG had dropped to below 3.5. RESULTS: Basal plasma concentration of aldosterone was higher than upper normal limit in 13(57%) patients, and correlated with TTKG significantly(r=0.60, p=0.002). TTKG was calculated to be 3.5+/-0.67 when assuming the aldosterone activity has been completely blocked. Spot urine [Na]/[K] ratio had significant negative correlation with TTKG before and after the administration of spironolactone. In most patients, diuretic response appeared with the fall of TTKG (especially below 3.5) and with the rise of spot urine [Na]/[K] ratio. In patients who did not respond to a low dose spironolactone, further treatment plan (to increase dose of spironolactone or to add furosemide) was guided by TTKG, and all were successful. CONCLUSIONS: TTKG and spot urine [Na]/[K] ratio are good indicators of aldosterone activity, and might be used as useful guidelines in the diuretic management of cirrhotic ascites.
Aldosterone
;
Ascites*
;
Furosemide
;
Humans
;
Plasma
;
Potassium*
;
Spironolactone
4.Recurrent hypokalemia in an adult male: A case report on gitelman’s syndrome
Ralph Philip C. Nierre, MD ; Bayani Pocholo T. Maglinte, MD ; Jeremyjones F. Robles, MD
Philippine Journal of Internal Medicine 2023;61(2):72-76
Introduction:
Gitelman Syndrome (GS), a rare autosomal recessive inherited disorder, is frequently unrecognized in the
clinical setting. GS typically manifests with severe hypokalemia with debilitating and potentially fatal consequences if
untreated. As of writing, confirmatory genetic assays are currently unavailable in the country, and the diagnosis of GS is
primarily based on several biochemical laboratory tests. This results in the difficulty with prompt diagnosis of GS in the
locality.
Case:
We present a 52-year-old male who came in with chronic, intermittent paraparesis associated with persistent
hypokalemia. A diagnosis of GS was made biochemically based on renal wasting of potassium and magnesium,
hypocalciuria, and metabolic alkalosis. Electrolyte correction with lifelong supplementation, and administration of
Spironolactone resulted in the resolution of bilateral leg weakness. Electrolyte levels were maintained within normal limits
in the outpatient setting.
Conclusion
GS is an uncommon potentially debilitating disorder that may lead to problematic, potentially fatal
consequences to electrolyte abnormalities if left untreated. The lack of awareness and consequent delay in the diagnosis,
and the unavailability of confirmatory genetic testing remains a clinical challenge. Timely recognition and initiation of
treatment leads to early control of electrolyte levels, and better prognosis.
Gitelman&rsquo
;
s Syndrome
;
Paraparesis
;
Hypokalemia
;
Hypomagnesemia
;
Spironolactone
;
Case Report
5.Diffuse alopecia of a Female with Polycystic Ovarian Disease.
Seok Kweon YUN ; Gye Yeong SON ; Il Moon SONG ; Chull Wan IHM
Korean Journal of Dermatology 1996;34(6):1021-1025
A 19 year old female patient presented with diffuse alopecia as her chief medical complaint. A clinical examination revealed hirsutism limited only to the on midline lower abdomen with elevated DHEA-S(dehydroepiandrosterone sulfate) and total testosterone levels. Polycystic ovarian disease (PCOD) was diagnosed during the treatment with dexamethasone and spironolactone, which was effective to improve her alopecia. We believe that, with increasing, concerns about hair conditions of teen-age girls there should be increasing chances for dermatologists to care for patients of PCOD first before other specialities in medicine.
Abdomen
;
Alopecia*
;
Dexamethasone
;
Female*
;
Hair
;
Hirsutism
;
Humans
;
Ovarian Diseases*
;
Spironolactone
;
Testosterone
;
Young Adult
6.A Case of Aortic Dissection Ocurring in a Hypertensive Patient.
Chong Wook PARK ; Hyun Chul KWAK ; Hae Jin YOO ; Soon Hee PARK ; Dong Jun WON ; Jeong Sik PARK ; Gun Pil CHOI ; Hyo Jin LEE ; Soon Gil KIM
Korean Circulation Journal 1997;27(1):113-119
Primary aldosteronism is present in approximately 1% of unselectd hypertensive patients. Adrenal adenoma is a known as one of the surgically curable form of the hypertension. Hypertension is one of the contributing factors for the development of aortic dissection. Cincurrence of aortic dissection in patient with primary aldosteronism is extemely rare. Only one case wasconfirmed by autopsy and reported in the world literature. We report a case of DeBakey type 3 anortic aneursm in a 49-year old hypertensive female patient with primary aldosteronism due to left adrenal adenoma. She underwent left adrenalectomy uneventfully after stabilization of her blood pressure with maximal medical management including nitroprusside, aldactone, enalapril and inderal.
Adenoma
;
Adrenalectomy
;
Autopsy
;
Blood Pressure
;
Enalapril
;
Female
;
Humans
;
Hyperaldosteronism
;
Hypertension
;
Middle Aged
;
Nitroprusside
;
Propranolol
;
Spironolactone
7.The Effects of Magnesium Supplementation for Correcting Hypokalemia in Gitelman Syndrome.
Joong Don MOON ; Sang Woong HAN ; Ho Jung KIM
Korean Journal of Nephrology 2006;25(2):213-220
BACKGOUND: Gitelman's syndrome is manifested by hypokalemia, metabolic alkalosis, normal blood pressure, hyperreninemic hyperaldosteronism, hypomagnesemia and hypocalciuria. This study was carried out to investigate the effects of magnesium supplementation for correcting hypokalemia in Gitelman syndrome. METHODS: A Gitelman patient without hyperaldosteronism in our hospital was studied, oral supplementation periods of regimens for 60 days were divided into eight stages (each stage is at least over 5 days) such as 1 stage:no regimen supplementation period 2 stage:spironolactone 100 mg, alone period 3 stage:spironolactone 100 mg, MgO 1 g mixed period, 4 stage:spironolactone 100 mg, alone period, 5 stage:spironolactone 100 mg, MgO 1 g mixed period, 6 stage:spironolactone 150 mg, MgO 1 g mixed period, 7 stage: spironolactone 150 mg, MgO 1.5 g mixed period, 8 stage:spironolactone 150 mg, MgO 1.5 g, KCl 3.6 g mixed period. RESULTS: The highest value of plasm [K] was 3.3 mEq/L, the lowest value of TTKG was 2.6 during 3 stage, plasm [K] had tendency to increased and TTKG decreased, however next during 4 stage, the tendency of correcting hypokalemia diminished. The highest value of plasm [K] was only 3.3 mEq/L during 7 stage, the highest value of plasm [K] was 4.6 mEq/L during 8 stage. And the highest value of plasm ionized [Mg++] was 0.44 mmol/L during MgO 1.5 g supplementation. CONCLUSION: Magnesium alone fails to completely correct potassium and magnesium depletion despite tendency of correcting. Therefore, the optimal therapeutic regimens for correcting hypokalemia in Gitelman syndrome without hyperaldosteronism would be the magnesium and additional K supplementation.
Alkalosis
;
Blood Pressure
;
Gitelman Syndrome*
;
Humans
;
Hyperaldosteronism
;
Hypokalemia*
;
Magnesium*
;
Potassium
;
Spironolactone
;
Gitelman Syndrome
8.Establishment of HPLC-ESI-MS method for the determination of eplerenone in human plasma and its pharmacokinetics.
Wen-Juan QIAN ; Li DING ; Ai-Dong WEN ; Bin GONG ; Ye LENG ; Chang-Hong YUN ; Lin YANG
Acta Pharmaceutica Sinica 2009;44(7):771-777
A sensitive high performance liquid chromatography-electrospray ionization-mass spectrometry (HPLC-ESI-MS) method was established for the determination of eplerenone (EP) in human plasma. The plasma samples of EP were extracted with ethyl acetate and separated by HPLC on a reversed phase C18 column with a mobile phase of 10 mmol x L(-1) ammonium acetate water solution-methanol (30 : 70, v/v). EP was determined with electrospray ionization-mass spectrometry (ESI-MS) in the selected ion monitoring (SIM) mode. The calibration curves were linear over the range of 2-4 000 ng x mL(-1) for EP. The lower limit of quantification was 2 ng x mL(-1). The method has been successfully applied in the pharmacokinetic study of the EP tablets. The main pharmacokinetic parameters of EP after oral administration of 25 mg, 50 mg, 100 mg were as follows, t1/2: (4.9 +/- 2.1), (4.7 +/- 1.5), (5.9 +/- 1.2) h; AUC(0-infinity): (4 402 +/- 1 735), (8 150 +/- 2 509), (13 783 +/- 4 102) microg x h x L(-1); and MRT: (6.2 +/- 2.1), (6.6 +/- 1.3), and (7.2 +/- 1.6) h. Parameters of EP after oral administration of multiple doses of 50 mg were as follows, t1/2: (6.1 +/- 1.7) h; AUC(ss): (10 071 +/- 4220) microg x h x L(-1); MRT: (8.1 +/- 2.3) h; and DF: (3.2 +/- 1.0).
Chromatography, High Pressure Liquid
;
methods
;
Humans
;
Spectrometry, Mass, Electrospray Ionization
;
methods
;
Spironolactone
;
analogs & derivatives
;
blood
;
pharmacokinetics
9.Efficacy of low-dose spironolactone on top of angiotensin receptor blockade in patients with glomerulonephritis.
Byung Chul YU ; Min Sung LEE ; Jong Joo MOON ; Soo Jeong CHOI ; Jin Kuk KIM ; Seung Duk HWANG ; Moo Yong PARK
Kidney Research and Clinical Practice 2018;37(3):257-265
BACKGROUND: Previous studies have shown that aldosterone antagonists have a proteinuria-lowering effect in patients with proteinuria and progressive proteinuric disease not adequately controlled by the use of angiotensin receptor blockers (ARBs). Aldosterone antagonists, in combination with ARBs, might improve proteinuria in patients with glomerulonephritis (GN). METHODS: In the present retrospective study, we evaluated the proteinuria-lowering effect and drug safety of low-dose spironolactone (12.5 mg/day) in 42 patients with GN being treated with an ARB. RESULTS: Proteinuria decreased from a mean total-protein-to-creatinine (TP/Cr) ratio of 592.3 ± 42.0 mg/g at baseline to 335.6 ± 43.3 mg/g after three months of treatment with spironolactone (P < 0.001). After the initial three months, the mean TP/Cr ratio increased progressively at six, nine, and 12 months; however, it was still less than the baseline value (P = 0.001, < 0.001, and < 0.001, respectively). Although serum Cr levels increased significantly at three and nine months compared with baseline (P = 0.036 and 0.026, respectively), there was no time effect of treatment (P = 0.071). Serum potassium levels tended to increase with time (P = 0.118), whereas systolic and diastolic blood pressures decreased with time (P = 0.122 and 0.044, respectively). CONCLUSION: Low-dose spironolactone in combination with an ARB reduced proteinuria in patients with GN, which could represent a novel treatment option in individuals whose proteinuria is not optimally controlled by the use of ARBs alone.
Angiotensin Receptor Antagonists
;
Angiotensins*
;
Glomerulonephritis*
;
Humans
;
Mineralocorticoid Receptor Antagonists
;
Potassium
;
Proteinuria
;
Retrospective Studies
;
Spironolactone*
10.Hypersexuality in Dementia.
Journal of Korean Geriatric Psychiatry 2003;7(1):76-82
PURPOSE: Hypersexual behavior such as increased libido, change in sexual orientation or disinhibition had been reported in dementia. Mechanism and treatment measures were reviewed. METHOD: A medline search was undertaken for papers written by English since 1970. RESULTS: Careful evaluation of past medical and sexual history should be undertaken as well as review of medication. SSRIs may be the first line because they are relatively safe. And then antiandrogens, estrogens or gonadotropin releasing hormone analogues can be tried. Effect of atypical antipsychotics or acetylcholinesterase inhibitors were also suggested. CONCLUSIONS: Symptoms of hypersexuality in dementia often cause feelings of embarrasment and become immense burden to relatives and healthworkers. Some pharmacological agents were promising. For example, combination of cimetidine or spironolactone and a cholinesterase inhibitor can be useful.
Androgen Antagonists
;
Antipsychotic Agents
;
Cholinesterase Inhibitors
;
Cholinesterases
;
Cimetidine
;
Dementia*
;
Estrogens
;
Gonadotropin-Releasing Hormone
;
Humans
;
Libido
;
Sexual Behavior
;
Spironolactone