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Atrial natriuretic factor in human autonomie failure

Department of Neurology (Drs. Kaufmann, Oribe, and Yahr) and Fishberg Research Center in Neurobiology (Drs. Pierotti and Roberts), Mount Sinai School of Medicine of the City University of New York, New York, NY.

To investigate whether excessive circulating levels of atrial natriuretic factor (ANF) are responsible for orthostatic hypotension and nocturnal polyuria in patients with autonomic failure, we determined the circadian variation in the plasma concentration of ANF as well as the response of this peptide to changes in posture and extracellular fluid volume in patients with autonomic failure. We found that the plasma concentration of ANF was significantly lower in patients with autonomie failure than in controls. Patients with autonomic failure had a significantly higher urinary sodium excretion during the night (8 pm to 8 am) than during the day (8 am to 8 pm), and the plasma concentration of ANF significantly decreased during the night in these patients, indicating that high circulating levels of ANF were not the cause of the nocturnal natriuresis. Furthermore, circulating levels of ANF responded appropriately to reductions in right atrial pressure induced by head-up tilt and extracellular fluid volume changes induced by mineralocorticoid administration. These results indicate that exaggerated circulating levels of ANF are not responsible for the orthostatic hypotension or nocturnal natriuresis in patients with autonomic failure, and that appropriate regulation of ANF occurs in patients with autonomic failure.

Address correspondence and reprint requests to Dr. Horacio Kaufmann, Department of Neurology, Mount Sinai School of Medicine, New York, NY 10029.

Supported in part by NIH grant # NS-11631 and NS-07245 from NINDS and R-R 71 from the Division of Research Resources of the NIH.

Presented in part at the 40th annual meeting of the American Academy of Neurology, Cincinnati, OH, April 1988.

Received March 8, 1989. Accepted for publication in final form December 21, 1989.

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