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

F. Mantero, D. Armanini, G. Opocher, F. Fallo, L. Sampieri, B. Cuspidi, C. Ambrosi, G. Faglia

Research output: Contribution to journalArticle

16 Citations (Scopus)

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 patients 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 9α-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 took longer to return to normal, varying from case to case; in all but one patient, the values returned to normal within two months. This report reveals another cause of factitious mineralocorticoid excess which may be considered in the differential diagnosis of hypokalemic hypertensive syndromes.

Original languageEnglish
Pages (from-to)352-357
Number of pages6
JournalAmerican Journal of Medicine
Volume71
Issue number3
DOIs
Publication statusPublished - 1981

Fingerprint

Nasal Sprays
Mineralocorticoids
Hypertension
Hypokalemia
Renin
Aldosterone
Hydrocortisone
18-Hydroxycorticosterone
Aminoglutethimide
Glycyrrhiza
Desoxycorticosterone
Alkalosis
Spironolactone
Amiloride
Vasoconstrictor Agents
Rhinitis
Corticosterone
Adrenocorticotropic Hormone
Dexamethasone
9-fluoroprednisolone

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Mineralocorticoid hypertension due to a nasal spray containing 9α-fluoroprednisolone. / Mantero, F.; Armanini, D.; Opocher, G.; Fallo, F.; Sampieri, L.; Cuspidi, B.; Ambrosi, C.; Faglia, G.

In: American Journal of Medicine, Vol. 71, No. 3, 1981, p. 352-357.

Research output: Contribution to journalArticle

Mantero, F, Armanini, D, Opocher, G, Fallo, F, Sampieri, L, Cuspidi, B, Ambrosi, C & Faglia, G 1981, 'Mineralocorticoid hypertension due to a nasal spray containing 9α-fluoroprednisolone', American Journal of Medicine, vol. 71, no. 3, pp. 352-357. https://doi.org/10.1016/0002-9343(81)90153-4
Mantero, F. ; Armanini, D. ; Opocher, G. ; Fallo, F. ; Sampieri, L. ; Cuspidi, B. ; Ambrosi, C. ; Faglia, G. / Mineralocorticoid hypertension due to a nasal spray containing 9α-fluoroprednisolone. In: American Journal of Medicine. 1981 ; Vol. 71, No. 3. pp. 352-357.
@article{0fa9bbacf6b74beb99120adf3d6ea233,
title = "Mineralocorticoid hypertension due to a nasal spray containing 9α-fluoroprednisolone",
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 patients 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 9α-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 took longer to return to normal, varying from case to case; in all but one patient, the values returned to normal within two months. This report reveals another cause of factitious mineralocorticoid excess which may be considered in the differential diagnosis of hypokalemic hypertensive syndromes.",
author = "F. Mantero and D. Armanini and G. Opocher and F. Fallo and L. Sampieri and B. Cuspidi and C. Ambrosi and G. Faglia",
year = "1981",
doi = "10.1016/0002-9343(81)90153-4",
language = "English",
volume = "71",
pages = "352--357",
journal = "American Journal of Medicine",
issn = "0002-9343",
publisher = "Elsevier Inc.",
number = "3",

}

TY - JOUR

T1 - Mineralocorticoid hypertension due to a nasal spray containing 9α-fluoroprednisolone

AU - Mantero, F.

AU - Armanini, D.

AU - Opocher, G.

AU - Fallo, F.

AU - Sampieri, L.

AU - Cuspidi, B.

AU - Ambrosi, C.

AU - Faglia, G.

PY - 1981

Y1 - 1981

N2 - 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 patients 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 9α-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 took longer to return to normal, varying from case to case; in all but one patient, the values returned to normal within two months. This report reveals another cause of factitious mineralocorticoid excess which may be considered in the differential diagnosis of hypokalemic hypertensive syndromes.

AB - 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 patients 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 9α-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 took longer to return to normal, varying from case to case; in all but one patient, the values returned to normal within two months. This report reveals another cause of factitious mineralocorticoid excess which may be considered in the differential diagnosis of hypokalemic hypertensive syndromes.

UR - http://www.scopus.com/inward/record.url?scp=84879282649&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84879282649&partnerID=8YFLogxK

U2 - 10.1016/0002-9343(81)90153-4

DO - 10.1016/0002-9343(81)90153-4

M3 - Article

VL - 71

SP - 352

EP - 357

JO - American Journal of Medicine

JF - American Journal of Medicine

SN - 0002-9343

IS - 3

ER -