Aldosterone excretion in normal children and in children with adrenal hyperplasia.

Abstract

A new double isotope dilution derivative method for assaying urinary tetrahydroaldosterone glucuronide and a modification of a previously-published double isotope dilution derivative technique for urinary aldosterone are presented. These are highly specific and sensitive determinations. The double isotope dilution derivative technique was used to measure the excretion of the 3 major metabolites of aldosterone-free aldosterone, 3-oxocon-jugate of aldosterone, and tetrahydroaldosterone glucuronide in a large number of children of all ages, both normal and with salt-losing and simple virilizing adrenal hyperplasia. Secretion rates of aldosterone were also measured by the same technique. When correlated for surface area, aldosterone levels of normal children and patients with simple virilizing adrenal hyperplasia are equivalent to those of adults, but are very low in children with salt-wasting adrenal hyperplasia. Under the stress of salt restriction, salt losers cannot increase aldosterone production, but simple virilizers show a 3-fold increase. The ratio of aldosterone metabolites in the urine of children is similar to that in the urine of adults. These results support the hypothesis that aldosterone deficiency is an important factor in salt-wasting adrenal hyperplasia.