CIRCULATING LEVELS OF ADRENOMEDULLIN IN PATIENTS WITH ADDISONS-DISEASE BEFORE AND AFTER CORTICOSTEROID TREATMENT

BACKGROUND AND OBJECTIVE A novel hypotensive peptide, adrenomedullin ( AM), had recently been isolated, purifed and its encoding gene sequenc ed from a human phaeochromocytoma. In humans AM circulates in physiolo gical levels and possesses a distinct vasodilatatory activity. The pur pose of this study was to examine the behaviour of AM levels in primar y adrenal failure, DESIGN Plasma AM levels were measured in patients w ith proven Addison's disease using a specific radioimmunoassay and com pared to those in healthy normotensive subjects. PATIENTS Eighteen pat ients with Addison's disease (10 men and eight women; ages 21 to 72 ye ars) and 21 healthy control subjects (13 men and eight women; ages 20 to 71 years) were enrolled in the study. All patients were studied und er basal conditions and 10 were reassessed following corticosteroid tr eatment. RESULTS All patients with Addison's disease showed increased levels of AM compared to the control group. Mean plasma AM levels were correspondingly higher in patients with Addison's disease than in nor mal subjects (102.1 +/- 33.4 (SD) ng/l versus 13.7 +/- 6.1 ng/l; P < 0 .0001). In 10 patients studied after corticosteroid treatment, plasma AM levels were significantly reduced (P < 0.0001: 110.3 +/- 35.8 ng/l versus 32.4 +/- 10.3 ng/l) after 2 weeks of treatment. A weak correlat ion (r = 0.458; P = 0.048) was observed between systolic blood pressur e plasma AM concentrations in all patients Addison's disease. CONCLUSI ONS These results indicate a consistent but reversible increase of adr enomedullin in patients with Addison's disease.