How is the metoclopramide (Reglan) test performed in the workup of primary aldosteronism?

Updated: Mar 24, 2020
  • Author: Gabriel I Uwaifo, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Answer

Under normal conditions, dopamine causes tonic inhibition of aldosterone, whereas serotonin (5-HT) causes increased aldosterone secretion in vivo. Metoclopramide is a D2 dopamine receptor antagonist, as well as a serotonin receptor-4 (5-HT4) partial agonist, and, hence, its administration leads in increased aldosterone levels. This normal pattern of response is retained in patients with aldosteronomas and low-renin hypertension (HTN), but not in patients with IAH. [40]

Following a 10-mg intravenous injection of metoclopramide, serum aldosterone levels increase significantly in patients with aldosteronomas, but they remain either unchanged or paradoxically reduced in patients with IAH. This test saw some increased usage in the mid 1990s, especially in Europe, but is rather rarely used in the United States today.


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