Down-regulation of renin-aldosterone and antidiuretic hormone systems in patients with M.E. / C.F.S

[Kyla]

http://www.ncbi.nlm.nih.gov/pubmed/27401397

J Cardiol. 2016 Jul 8. pii: S0914-5087(16)30120-4. doi: 10.1016/j.jjcc.2016.06.003. [Epub ahead of print]
Down-regulation of renin-aldosterone and antidiuretic hormone systems in patients with myalgic encephalomyelitis/chronic fatigue syndrome.
Miwa K1.
Author information

Abstract
BACKGROUND:
Central nervous system dysfunction associated with myalgic encephalomyelitis (ME) has been postulated as the cause of chronic fatigue syndrome (CFS). A small heart or reduced left ventricular volume with reduced cardiac output has been reported to be common in patients with ME. The main circulatory blood volume regulators may be down-regulated.

METHODS:
Plasma levels of the neurohumoral factors that regulate circulatory blood volume were determined in 18 patients with ME and 15 healthy subjects (Controls).

RESULTS:
The echocardiographic examination revealed that the mean values for the left ventricular end-diastolic diameters, stroke volume index, and cardiac index as well as the mean blood pressure were all significantly smaller in the ME group than in the Controls. The mean plasma renin activity (1.6±1.0ng/ml/h vs. 2.5±1.5ng/ml/h, p=0.06) was considerably lower in the ME group than in the Controls. Both the mean plasma aldosterone (104±37pg/ml vs. 157±67pg/ml, p=0.004) and antidiuretic hormone (ADH) (2.2±1.0pg/ml vs. 3.3±1.5pg/ml, p=0.02) concentrations were significantly lower in the ME group than in the Controls. Desmopressin (120μg), a synthetic version of arginine vasopressin, was orally administered for five successive days to 10 patients with ME. In five patients (50%), the symptoms of orthostatic intolerance during a 10min active standing test were ameliorated in association with a significant increase in urinary osmotic pressure and decrease in heart rate. Furthermore, in five patients (50%), the performance status scores for the activities of daily living were improved.

CONCLUSIONS:
Both the renin-aldosterone and ADH systems were down-regulated despite the existence of reduction in cardiac preload and output in patients with ME. Desmopressin improved symptoms in half of the patients.

Copyright © 2016 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

KEYWORDS:
Antidiuretic hormone; Chronic fatigue syndrome; Desmopressin; Myalgic encephalomyelitis; Renin–aldosterone system

PMID:

27401397

DOI:

10.1016/j.jjcc.2016.06.003

 

[Snow Leopard]

In case anyone was wondering, reduced vasopressin (ADH) has been found in other studies too and could be the cause for the slightly reduced cortisol found in the blood of CFS patients vs controls. (rather than any dysfunction of the adrenal glands). Vasopressin in turn is affected by adrenergic and cholinergic signalling, which would tie this in with the other autonomic and vascular dysfunction observed. And may tie in with some of the more interesting studies done recently. [1] [2]

Vasopression also plays a key role in renal function:
http://forums.phoenixrising.me/inde...ered-renal-function-in-me-cfs-patients.45626/
See also: http://arbl.cvmbs.colostate.edu/hbooks/pathphys/endocrine/hypopit/adh.html

 

[roller]

parasites (worms, leeches, or the many smaller bugs) would logically change the osmotic system as well, what the body then tries to balance via vasopressin and the kidneys ???

 

[roller]

*osmotic pressure

 

[gregh286]

is aldosterone testing not a regular test in NHS?? Surely this marker would have been noticed before now.
Aldosterone and renin test measured together.

 

[John Mac]

A small left ventricle in M.E. patients is starting to get a few mentions now.

Here's Miwa's previous study:

http://forums.phoenixrising.me/inde...-myalgic-encephalomyelitis.29740/#post-454396

And Cort mentions Newton's study here:

http://www.healthrising.org/blog/2016/06/27/chronic-fatigue-syndrome-small-heart-disease/

" The big clue to all this appears to be the reduced left ventricle mass. If ME/CFS patients were deconditioned their entire heart should be smaller but only the left ventricle is. The left ventricle is where blood from the veins enters the heart. If blood flows to the LV are reduced the LV is going to be smaller simply because it’s not working out as much."

 

[Grigor]

It's interesting that I was a late bed wetter . Once I stopped sugar it went away. Hated it as kid of course. But could maybe be related?
Now drinking like a horse and piss like a fish. Or whatever Teitelbaum called it.

 

[Hip]

Down-regulation of renin-aldosterone and antidiuretic hormone systems in patients with myalgic encephalomyelitis/chronic fatigue syndrome.

Antidiuretic hormone (aka vasopressin) works to retain water in the body; thus its down-regulation I expect means that you will be urinating out more water.

This is precisely what I found since developing ME/CFS: I am both thirstier, drinking more water, and frequently going to the toilet to get rid of it!


You can get a vasopressin analogue drug called desmopressin, but it is a little expensive (around $2 a day). You can also buy vasopressin itself, but desmopressin is longer acting.

 

[adreno]

No surprises here. But why is it down-regulated?

 

[Hip]

No surprises here. But why is it down-regulated?

It says here that vasopressin is synthesized in the hypothalamus and is transported to the posterior pituitary.

Perhaps because the hypothalamus and HPA-axis is thought to be dysfunctional in ME/CFS, this affects vasopressin synthesis.


Control of the sleep cycle (circadian rhythm) is also centered in the hypothalamus, so a dysfunctional hypothalamus might in addition explain the circadian rhythm disruptions often found in ME/CFS.

And it is possible that hypothalamic dysfunction in ME/CFS might explain the emotional symptoms of ME/CFS (emotional sensitivity to social discord; flat emotions; labile emotions), since the hypothalamus plays a major role in emotional processing.

The hypothalamus also helps regulate the autonomic nervous system, and there is often autonomic dysfunction in ME/CFS (although this autonomic dysfunction might be explained by the adrenergic and muscarinic receptor autoantibodies that have been found in ME/CFS and POTS).

 

[Kyla]

You can get a vasopressin analogue drug called desmopressin, but it is a little expensive (around $2 a day). You can also buy vasopressin itself, but desmopressin is longer acting.

Woah. not sure why you are being charged so much but I take desmopressin and it is not nearly that expensive in Canada.

 

[Kyla]

is aldosterone testing not a regular test in NHS?? Surely this marker would have been noticed before now.
Aldosterone and renin test measured together.

its quite possible that even if it is significantly and consistently lower in patients than controls, it might not be consistently below the reference range.

Not sure how standard this test is elsewhere (or specifically in the NHS) but anecdotally, in Canada I have never had aldosterone tested at any time that I know of.

 

[Hip]

Woah. not sure why you are being charged so much but I take desmopressin and it is not nearly that expensive in Canada.

How much are you charged in Canada, may I ask? When I looked at the cost of desmopressin at online pharmacies, it seemed pretty expensive (around $2 for 0.1 mg):

http://www.unitedpharmacies.com/Minirin-Desmopressin-Acetate.html
http://www.pharmacygeoff.md/Minirin_Desmopressin_Acetate_01mg_30_Tablets_p_1542.html

 

[Kyla]

A lot of the cost for me is covered by a secondary health plan, but it looks like without any insurance the full cost including the filling fee would be $44 / month (30), it's not as cheap as I thought but still a lot less than $2 per pill. I would guess the online pharmacies are likely charging you a large markup for their service.

If you want to talk expensive...check out the price of ketotifen. It is INSANE. I am very very happy I have a drug plan (thanks to having an employed spouse). I have no idea how people are affording any treatment without one.

 

[msf]

It says here that vasopressin is synthesized in the hypothalamus and is transported to the posterior pituitary.

Perhaps because the hypothalamus and HPA-axis is thought to be dysfunctional in ME/CFS, this affects vasopressin synthesis.


Control of the sleep cycle (circadian rhythm) is also centered in the hypothalamus, so a dysfunctional hypothalamus might in addition explain the circadian rhythm disruptions often found in ME/CFS.

And it is possible that hypothalamic dysfunction in ME/CFS might explain the emotional symptoms of ME/CFS (emotional sensitivity to social discord; flat emotions; labile emotions), since the hypothalamus plays a major role in emotional processing.

The hypothalamus also helps regulate the autonomic nervous system, and there is often autonomic dysfunction in ME/CFS (although this autonomic dysfunction might be explained by the adrenergic and muscarinic receptor autoantibodies that have been found in ME/CFS and POTS).

From what I remember of what I´ve read, and from my own experience, it is downregulated because of the bacterial translocation. So when the translocation increases (normally through dietary changes) I wake up earlier to go to the toilet in the night, and I constantly have a dry mouth.