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Submitted on June 30, 2005
Accepted on January 23, 2006
INSERM U 413, Laboratory of Cellular and Molecular Neuroendocrinology, European Institute for Peptide Research (IFRMP 23), University of Rouen (V.P., C.D., H.L., J.L.D.R., H.V., J.M.K.), 76821 Mont-Saint-Aignan, France; INSERM Center for Clinical Investigation 204, University Hospital of Rouen (H.L., J.M.K.), 76031 Rouen, France
* To whom correspondence should be addressed. E-mail: hubert.vaudry{at}univ-rouen.fr.
Context: Arginine vasopressin (AVP) stimulates steroid secretion from the normal human adrenal gland and some cortisol-producing adrenocortical tumors or hyperplasia through activation of the V1a receptor.
Objective: To investigate in vitro and in vivo the possible involvement of AVP in the physiopathology of primary aldosteronism (PA).
Design: Immunohistochemical, pharmacological and molecular studies on aldosterone- producing adenoma (APA), followed by a monocentric, cross-over trial of the orally active V1a receptor antagonist, SR 49059, in a double blind, randomized and placebo-controlled fashion.
Setting: University hospital and research laboratory.
Patients: Eight untreated patients with PA, four with APA and four with idiopathic hyperaldosteronism (IH).
Main outcome measures: Aldosterone secretion of APA cells in vitro; plasma aldosterone, renin and ACTH.
Intervention: SR 49059 (200 mg once daily) or placebo during 2 one-week treatment periods separated by a two-week washout.
Results: We observed the occurrence of AVP-containing cells in APA tissues. Administration of AVP to perifused APA cells induced an increase in aldosterone production which was inhibited by a specific V1a antagonist. RT-PCR analysis showed the expression of V1a receptor mRNA in most APA studied. In APA patients, SR 49059 did not induce any effect on basal aldosterone secretion but provoked a plasma aldosterone response to orthostatism (P < 0.03) and strengthened the positive correlation between plasma aldosterone and ACTH.
Conclusion: The present study indicates that functionnal V1a receptors are present in APA and suggests that AVP may exert an autocrine/paracrine control of aldosterone secretion in APA tissues.
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