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Excretion of the mono- and divalent ions in relation to flow rate in bartter's and pseudo bartter's syndromes in parotid saliva. comparative studies to the syndrome of conn

Ausscheidung mono- und bivalenter Ionen in Beziehung zur Flußrate im Parotisspeichel beim Bartter- und Pseudo-Bartter-Syndrom. Vergleichende Untersuchungen zum Conn-Syndrom

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Summary

In three patients, one with Bartter's syndrome and two with pseudo-Bartter's syndrome, the excretion pattern of mono- and divalent ions of the parotid saliva was studied as a function of flow rate. The results were compared with those observed in normal adults and in two patients with Conn's syndrome.

In both Bartter's and pseudo-Bartter's syndromes, salivary K+ secretion was more than two times higher if compared with the corresponding flow rates. Other symptoms of the complex alterations of electrolyte transport in Bartter's and pseudo-Bartter's syndromes were the increased salivary excretion of calcium, magnesium, bicarbonate and inorganic phosphorus. Na+ reabsorption was slightly decreased in the patient with true Bartter's syndrome, and moderately increased in pseudo-Bartter's syndrome.

The typical feature in the two patients with Conn's syndrome showed to be an excessive increase of salivary sodium reabsorption. The total amount of sodium actively reabsorbed by the duct system (J*ac), exceeded the normal range by about a factor of 2–3. Simultaneously, and in contrast to Bartter's syndrome, the flow-dependent concentrations of bicarbonate were markedly and those of magnesium slightly lower. The concentrations of potassium and inorganic phosphorus were moderately elevated, whereas those of calcium were markedly increased.

Quantitative as well as qualitative differences in the salivary electrolyte patterns in these diseases provide strong arguments against an exclusive role of aldosterone in the pathogenesis of the electrolyte disturbances in Bartter's and pseudo-Bartter's syndrome.

Experiments on human parotid glands clearly demonstrate that alterations of transepithelial electrolyte transport in this disease are not only confined to the different segments of the renal tubulus, but seem to be a symptom of a generalized disturbance of electrolyte transport.

Zusammenfassung

Im pilocarpinstimulierten Parotisspeichel wurde beim Bartter- (n=1), Pseudo-Bartter- (n=2) und Conn-Syndrom (n=2) die Konzentration der mono- und bivalenten Ionen als Funktion der Flußrate untersucht. Des weiteren wurde nach einem mathematischen Ansatz von Knauf und Frömter (1970) die gesamte aktive Na+-Rückresorption einer Parotis sowie die passive Leckpermeabilität des Gangsystems für Na+ berechnet.

Führendes speichelchemisches Symptom desBartter- undPseudo-Bartter-Syndroms war eine Steigerung der aktiven K+-Sekretion, wobei der Normbereich um mehr als das Doppelte überschritten wurde. Die Na+-Reabsorption, die im Kontrollkollektiv mit 171±12 µ Äq/min berechnet wurde, verhielt sich unterschiedlich: leicht erniedrigt beim eehten Bartter-Syndrom, gering erhöht beim Pseudo-Bartter-Syndrom. Die flußratenbezogene Exkretion von Ca und z.T. auch Mg war bei allen Bartter-Kranken gesteigert. In ähnlicher Weise bestanden für die Anionen HCO 3− und anorg. Phosphat deutlich erhöhte Werte.

Im Unterschied zu diesen Befunden war der Elektrolyttransport beimConn-Syndrom durch eine exzessive Zunahme der Na+-Reabsorption gekennzeichnet. Trotz vermehrter Leckpermeabilität des Gangsystems wurde der Normbereich um den Faktor 2–3 überschritten. Die flußratenbezogene Konzentration von K+ und anorg. P war leicht, die des Ca stark erhöht. Erniedrigte Werte kennzeichneten die Bicarbonatsekretion — im Gegensatz zum Bartter-Syndrom.

Aufgrund der qualitativen und quantitativen Differenzen in der Speichelchemie beider Krankheitsbilder ist es zweifelhaft, daß Aldosteron allein für den veränderten Elektrolyttransport beim Bartter-Syndrom verantwortlich ist.

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Authors and Affiliations

  1. Departments of Internal Medicine and Otolaryngology, University of Würzburg, and Max-Planck-Institute for Biophysics, Frankfurt, West-Germany

    A. Heidland, W. Kreusser, H. Hennemann, H. Knauf & M. E. Wigand

  2. Univ.-Hals-Nasen-Ohren-Klinik, D-8700, Würzburg

    M. E. Wigand

  3. Department of Otolaryngology, D-8520, Erlangen-Nürnberg, Germany

    M. E. Wigand

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  1. A. Heidland
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  4. H. Knauf
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Heidland, A., Kreusser, W., Hennemann, H. et al. Excretion of the mono- and divalent ions in relation to flow rate in bartter's and pseudo bartter's syndromes in parotid saliva. comparative studies to the syndrome of conn. Klin Wochenschr 50, 959–966 (1972). https://doi.org/10.1007/BF01488069

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