Aldosterone Metabolism in Liver Disease

ABSTRACT Aldosterone secretion rates have been measured in six patients with cirrhosis of the liver using 16– 3 H aldosterone. The proportion of administered radioactivity excreted as p H 1 extractable conjugates and as a glucuronide has also been determined. On unrestricted diets the aldosterone secretion rates were 19, 85 and 94 μg/day in three patients with ascites and oedema, and 140, 170 and 386 μg/day in three without fluid retention. Five of these patients were restudied after at least seven days on a low sodium diet (20 – 30 meq./day) and slight increases of secretion rate observed. The levels obtained were much lower than those previously reported for normal subjects on a low sodium diet. One patient was studied on a subsequent occasion after a haematemesis (urine sodium 1 meq./day), the secretion rate was 1130 μg/day. The proportion of administered radioactivity excreted as glucuronide was below normal in at least one determination on four of the six patients and there was an increase of the proportion excreted as p H 1 extractable conjugates. There was a striking variation of the proportion of radioactivity excreted as p H 1 extractable conjugates. One patient was studied on five occasions and the range was from 6.0 to 25.2 % of the administered radioactivity. This suggests that in patients with cirrhosis of the liver the urinary p H 1 extractable aldosterone may have a variable relationship to the actual secretion rate.