Summary
A total of 47 neurosurgical patients with brain tumours have been studied. Twenty of them were not specifically treated for brain oedema before the operation and are being regarded as controls. In the other 27 patients aldosterone was given pre- and postoperatively for several days in a dose of 2×5 mg per day. During the operation, tissue samples from the vicinity of the tumour, including cortex and white matter, were removed and subjected to analysis of the following: water content, electrolytes (Na, K) and labile metabolites (CP, ATP, ADP, AMP, Pyr., Lact.). When comparing the two groups, a reduction of water content was found in the aldosterone group with a statistical significance at p 0.005. Na was at lower values in both brain compartments in the treated group, whereas K was found to be slightly elevated above the level of the controls. Metabolites showed only minor changes when the 2 groups were compared. From the clinical point of view, patients responded favourably to aldosterone therapy. In no case did treatment with aldosterone result in untoward side effects.
Similar content being viewed by others
References
Addison, T., Diseases of suprarenal capsules (1855). Reprinted in: Medical Classics2, 233. London: Highley. 1937.
Atkinson, D. E., The energy charge of the adenylate pool as a regulatory parameter. Biochem.7 (1968), 4030–4034.
Baethmann, A., Kh. R. Koczorek, H. J. Reulen, W. Wesemann, H. F. Hofmann, A. Angstwurm und W. Brendel, Die Beeinflussung des traumatischen Hirnödems durch Aldosteron, Aldosteronantagonisten und Dexamethason im Tierexperiment. In: Bücherl, E. S., et al. (Eds.): Postoperative Störungen des Elektrolyt- und Wasserhaushaltes, S. 163–175. Stuttgart-New York: F. K. Schattauer. 1968.
, W. Brendel, Kh. R. Koczorek und R. Enzenbach, Pathophysiologie des traumatischen Hirnödems. DMW18 (1970), 1020–1024.
, and A. Van Harreveld, Physiological and biochemical findings in the central nervous system of adrenalectomized rats and mice. In: Reulen, H. J., and K. Schürmann (Eds.): Steroids and brain edema, p. 195–202. Berlin-Heidelberg-New York: Springer. 1972.
, Effect of adrenal insufficiency on water and electrolyte distribution in the brain. J. Neuropath. Exp. Neurol.32, 3 (1973), 394–407.
Cantu, R. C., H. Amir-Ahmadi, and A. Prieto, Evaluation of the increased risk of gastro-intestinal bleeding following intracranial surgery in patients recieving high steroid dosages in the immediate post-operative period. Int. Surg. Dig.50 (1968), 325–335.
Conn, J. W., Primary aldosteronism. J. Lab. Clin. Med.45 (1955), 661.
Edelman, I. S., Aldosterone and sodium transport. In: Functions of the adrenal cortex.1, 79–174. Amsterdam: North Holland Publ. Co. 1968.
Fisher, C. E., J. Woo, and R. Horton, Effect of spirolactone on aldosterone and renin in normal man and in primary aldosteronism (PA). Clin. Res.20, 2 (1972), 217.
Fischer, G., and L. Mansuy, Notre experience de la soludactone en neurochirurgie. In: Extrarenal activity of aldosterone and its antagonists, p. 232–233. Amsterdam: Excerpt. Med. Found. 1972.
Kaplan, N. M., Secondary aldosteronism: with observations on the definition of hypokalemia. Amer. J. Clin. Path.54, 3 (1970), 316–323.
Koczorek, Kh. R., A. Angstwurm, A. Baethmann, D. Engelhardt, H. J. Reulen, P. Schmiedek, W. Vogt, B. Simon, E. Frick und W. Brendel, Aldosteronausscheidung beim Pseudotumor cerebri — einer klinischen Form des Hirnödems unbekannter Ursache. In: Bücherl, E. S., et al. (Eds.): Postoperative Störungen des Elektrolyt- und Wasserhaushaltes, S. 177–188. Stuttgart-New York: F. K. Schattauer. 1968.
Larsen, E. H., Characteristics of aldosterone stimulated transport in isolated skin of the toad, bufo bufo. J. Steroid Biochem.3 (1972), 111–120.
Maxwell, R. E., D. M. Long, and L. A. French, The clinical effects of a synthetic gluco-corticoid used for brain edema in the practice of neurosurgery. In: Reulen, H. J., and K. Schürmann: Steroids and brain edema, p. 219–232. Berlin-Heidelberg-New York: Springer. 1972.
Reulen, H. J., Vor- und Nachteile der osmotischen Behandlung des Hirnödems. Zentralbl. Neurochir.26, 4 (1965), 232–249.
, F. Medzihradsky, R. Enzenbach, F. Marguth, and W. Brendel, Electrolytes, fluids and energy metabolism in human cerebral edema. Arch. Neurol.21 (1969), 517–525.
—, M. Samii, Kh. R. Koczorek, A. Baethmann, and K. Schürmann, Diuretics in cerebral edema. In: Thurau, K., and H. Jahrmärker (Eds.): Renal transport and diurectics, p. 469–479. Berlin-Heidelberg-New York: Springer. 1969.
, A. Hadjidimos, and K. Schürmann, The effect of dexamethasone on water and electrolyte content and on rCBF in perifocal brain edema in man. In: Reulen, H. J., and K. Schürmann (Eds.): Steroids and brain edema, p. 239–252. Berlin-Heidelberg-New York: Springer. 1972.
Rohrschneider, I., I. Schinko und P. Schmiedek, Licht- und elektronen-mikroskopische Untersuchungen an der Zona glomerulosa des Hundes nach Behandlung mit Spirolacton. Res. exp. Med.159 (1972), 321–332.
Schmiedek, P., A. Baethmann, W. Brendel, E. Schneider, R. Enzenbach, and F. Marguth, Treatment of cerebral edema in man with spirolactone. In: Brock, M., and H. Dietz (Eds.): Intracranial pressure, p. 254–260. Berlin-Heidelberg-New York: Springer. 1972.
, G. Sippel, W. Oettinger, R. Enzenbach, F. Marguth, and W. Brendel, Energy state and glycolysis in human cerebral edema. The application of a new freeze-stop technique. J. Neurosurg.40 (1974), 351–364.
Wesemann, W., und H. W. Pia, Aldadiene-Kalium in der Neurochirurgie. In: Bücherl, E. S., et al. (Eds.): Postoperative Störungen des Elektrolyt- und Wasserhaushaltes, S. 259–270. Stuttgart-New York: F. K. Schattauer. 1968.
Woodbury, D. M., and A. Koch, Effects of aldosterone and desoxycorticosterone on tissue electrolytes. Proc. Soc. exp. Biol. (N.Y.)94 (1957), 720–723.
- Biochemical effects of adrenocortical steroids on the central nervous system. In: Lajtha, A. (Ed.): Handbook of neurochemistry7, 13, 255–287, Plenum Press. 1972.
Author information
Authors and Affiliations
Additional information
Supported by DFG-Sonderforschungsbereich 51 — Medizinische Molekularbiologie und Biochemie.
Rights and permissions
About this article
Cite this article
Schmiedek, P., Oettinger, W., Baethmann, A. et al. Aldosterone—A new therapeutic principle for the treatment of brain oedema in man. Acta neurochir 30, 59–68 (1974). https://doi.org/10.1007/BF01405755
Issue Date:
DOI: https://doi.org/10.1007/BF01405755