Dexamethasone suppression test: corticosteroid receptors regulation in mononuclear leukocytes of young and aged subjects.

The dexamethasone suppression test (DST) is considered an indicator of the function of the adrenal pituitary axis. The effect of the steroid is mediated by its binding to corticosteroid receptors. We previously suggested that the measurement of corticosteroid receptors in lymphocytes is an index of an analogous pattern in brain.

Further studies on the mechanism of the mineralocorticoid action of licorice in humans.

The pathogenesis of pseudohyperaldosteronism from licorice has been evaluated in 6 male volunteers taking daily 7 g of a commercial preparation of licorice for 7 days, corresponding to an intake of 500 mg/day of glycyrrhizic acid. Pseudohyperaldosteronism was evident during the treatment (increase of body weight, suppression of plasma renin activity and plasma aldosterone, reduction of serum potassium). The ratio (tetrahydrocortisol + allo tetrahydrocortisol)/tetrahydrocortisone in urine increased in 5 cases after 3 days of treatment, without an increase of plasma mineralocorticoid activity (PMA).

Regulation of aldosterone receptors in hypertension.

Mean mineralocorticoid receptor number in mononuclear leukocytes of patients with increased plasma aldosterone (Conn's syndrome, nephrovascular hypertension, preeclampsia) is lower than in controls and this reduction could be the consequence of a down-regulation of the receptor. A similar pattern is evident also in situations of excess of other mineralocorticoids (Cushing's syndrome, chronic licorice ingestion). In essential hypertension 20% of cases have reduced number of mineralocorticoid receptors in mononuclear leukocytes without increase of aldosterone and normal serum potassium.

Corticosteroid receptors and aging.

We have measured plasma aldosterone, plasma cortisol, and glucocorticoid and mineralocorticoid receptors in mononuclear leukocytes in 54 healthy aged subjects (60-97 years old) and in a group of 21 controls (21-50 years old). In addition all parameters and age were plotted for correlation. Plasma cortisol was significantly higher in the aged group (346 +/- 140 nmol/l) than in controls (260 +/- 120).

Corticosteroid receptors and lymphocyte subsets in mononuclear leukocytes in aging.

Plasma cortisol and aldosterone levels and number of related receptors in mononuclear leukocytes were measured in 49 healthy aged subjects (62-97 yr) and in 21 adult controls (21-50 yr). In all subjects, in addition, lymphocyte subsets were determined as an index of corticosteroid action. The mean number of type I and type II receptors was significantly lower in aged subjects than in controls (respectively, 198 +/- 96 and 272 +/- 97 receptors/cell for type I, and 1,794 +/- 803 and 3,339 +/- 918 for type II receptors).

Pseudohyperaldosteronism from liquorice-containing laxatives.

Four cases of pseudohyperaldosteronism due to chronic ingestion of liquorice-containing laxatives are described. All patients had hypertension and hypokalemia with suppression of plasma renin activity and aldosterone; the diagnosis was based only on retrospective grounds. In patients with hypokalemia and hypertension a possibility of such a cause must be excluded to avoid unnecessary diagnostic procedures.