Hypoaldosteronism pathophysiology: Difference between revisions
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* Drugs inhibiting aldosterone effect: NSAID, spironolactone, and triamterene | * Drugs inhibiting aldosterone effect: NSAID, spironolactone, and triamterene | ||
===Secondary Isolated Hypoaldosteronism=== | |||
Hyperreninemic hypoaldosteronism is seen in patients with severe illness such as sepsis, malignancy, heart failure, and liver cirrhosis. During these [[Stress (medicine)|stress]] inducing conditions, there occurs increased level of ACTH and cortisol. Under normal conditions, continuous ACTH secretion for > 96 hours leads to suppression of aldosterone synthase activity. Thus, chronically ill patients with prolonged ACTH secretion (>96 hours) have impaired aldosterone synthase activity and decreased levels of aldosterone. In response, the kidneys via its neurohormonal regulation leads to increased levels of renin and hence the term hyperreninemic hypoaldosteronism. In addition, cytokine release from chronic illness and increased levels of atrial natriuretic peptide (in patients with heart failure) also have an inhibitory effect on zona glomerulosa. | |||
<ref name="pmid6291814">{{cite journal |vauthors=Kater CE, Biglieri EG, Brust N, Chang B, Hirai J |title=Regulation of the mineralocorticoid hormones in adrenocortical disorders with adrenocorticotropin excess |journal=Clin Exp Hypertens A |volume=4 |issue=9-10 |pages=1749–58 |year=1982 |pmid=6291814 |doi= |url=}}</ref><ref name="pmid6256154">{{cite journal |vauthors=Aguilera G, Fujita K, Catt KJ |title=Mechanisms of inhibition of aldosterone secretion by adrenocorticotropin |journal=Endocrinology |volume=108 |issue=2 |pages=522–8 |year=1981 |pmid=6256154 |doi=10.1210/endo-108-2-522 |url=}}</ref><ref name="pmid1851063">{{cite journal |vauthors=Singer DR, Shirley DG, Markandu ND, Miller MA, Buckley MG, Sugden AL, Sagnella GA, MacGregor GA |title=How important are suppression of aldosterone and stimulation of atrial natriuretic peptide secretion in the natriuretic response to an acute sodium load in man? |journal=Clin. Sci. |volume=80 |issue=4 |pages=293–9 |year=1991 |pmid=1851063 |doi= |url=}}</ref> | |||
==Pathophysiology== | ==Pathophysiology== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
The exact pathogenesis of [disease name] is not fully understood.
OR
It is thought that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].
OR
[Pathogen name] is usually transmitted via the [transmission route] route to the human host.
OR
Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.
OR
[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].
OR
The progression to [disease name] usually involves the [molecular pathway].
OR
The pathophysiology of [disease/malignancy] depends on the histological subtype.
Pathophysiology
Hypoaldosteronism is defined as decreased levels of the hormone aldosterone (Normal range: 1-21 ng/dL). Hypoaldosteronism from decreased aldosterone synthesis can be due to :
- Adrenal Insufficiency: Primary or secondary
- Enzyme deficiency: Aldosterone synthase, 21 hydroxylase, and 11B hydroxylase
- Renal disorders: Chronic renal failure and diabetic nephropathy
- Drugs inhibiting aldosterone effect: NSAID, spironolactone, and triamterene
Secondary Isolated Hypoaldosteronism
Hyperreninemic hypoaldosteronism is seen in patients with severe illness such as sepsis, malignancy, heart failure, and liver cirrhosis. During these stress inducing conditions, there occurs increased level of ACTH and cortisol. Under normal conditions, continuous ACTH secretion for > 96 hours leads to suppression of aldosterone synthase activity. Thus, chronically ill patients with prolonged ACTH secretion (>96 hours) have impaired aldosterone synthase activity and decreased levels of aldosterone. In response, the kidneys via its neurohormonal regulation leads to increased levels of renin and hence the term hyperreninemic hypoaldosteronism. In addition, cytokine release from chronic illness and increased levels of atrial natriuretic peptide (in patients with heart failure) also have an inhibitory effect on zona glomerulosa. [1][2][3]
Pathophysiology
Pathogenesis
- The exact pathogenesis of [disease name] is not fully understood.
OR
- It is thought that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].
- [Pathogen name] is usually transmitted via the [transmission route] route to the human host.
- Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.
- [Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].
- The progression to [disease name] usually involves the [molecular pathway].
- The pathophysiology of [disease/malignancy] depends on the histological subtype.
Genetics
- Gene involved in the pathogenesis of hypoaldosteronism include mutation in CYP11B2 gene, which is located on chromosome 8q24.
- Mutation in CYP11B2 gene is transmitted in autosomal recessive pattern.
- The CYP11B2 gene encodes for the enzyme aldosterone synthase (previously known as corticosterone methyloxidase).
- Aldosterone synthase catalyses the conversion of 11 Deoxycorticosterone to aldosterone
| 11 Deoxycorticosterone | |||||||||||||||||||
| Corticosterone | |||||||||||||||||||
| 18 Hydroxycorticosterone | |||||||||||||||||||
| Aldosterone | |||||||||||||||||||
- Mutations in CYP11B2 can lead to:
- Type 1 aldosterone synthase deficiency: Patients have normal to decreased levels of 18-hydroxycorticosterone and undetectable levels of aldosterone.
- Type 2 aldosterone synthase deficiency: Patients have increased levels of 18-hydroxycorticosterone and normal to decreased levels of aldosterone.
- Aldosterone synthase is a member of the cytochrome P450 family of enzymes.
Associated Conditions
Gross Pathology
- On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
Microscopic Pathology
- On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
References
- ↑ Kater CE, Biglieri EG, Brust N, Chang B, Hirai J (1982). "Regulation of the mineralocorticoid hormones in adrenocortical disorders with adrenocorticotropin excess". Clin Exp Hypertens A. 4 (9–10): 1749–58. PMID 6291814.
- ↑ Aguilera G, Fujita K, Catt KJ (1981). "Mechanisms of inhibition of aldosterone secretion by adrenocorticotropin". Endocrinology. 108 (2): 522–8. doi:10.1210/endo-108-2-522. PMID 6256154.
- ↑ Singer DR, Shirley DG, Markandu ND, Miller MA, Buckley MG, Sugden AL, Sagnella GA, MacGregor GA (1991). "How important are suppression of aldosterone and stimulation of atrial natriuretic peptide secretion in the natriuretic response to an acute sodium load in man?". Clin. Sci. 80 (4): 293–9. PMID 1851063.