Causes of Hypoaldosteronism and Hormonal Profiles
| Causes of Hypoaldosteronism | Hormonal Profiles |
|---|---|
| DEFECTIVE STIMULATION OF ALDOSTERONE | |
| ❖ Congenital keep tablehyporeninemic hypoaldosteronism ❖ Acquired hyporeninemic hypoaldosteronism Associated with diabetes mellitus Associated with nephropathy Glomerulonephritis Gouty nephritis Pyelonephritis Nephropathy associated with multiple myeloma Nephropathy associated with systemic lupus erythematosa Mixed cryoglobulinemia Nephrolithiasis Analgesic nephropathy Renal amyloidosis Iga nephropathy ❖ Associated with autonomic insufficiency ❖ Associated with liver cirrhosis ❖ Associated with sickle cell anemia ❖ Associated with acquired immune deficiency syndrome ❖ Associated with polyneuropathy, organomegaly, endocrinopathy, m protein and skin changes syndrome ❖ Lead poisning ❖ Excess sodium bicarbonate ❖ Sjogren's syndrome ❖ Drugs interfering with renin production Β-blocker Prostaglandin synthetase inhibitors Non-steroidal anti-inflammatory drugs Calcium channel blocker ❖ Other drugs Cyclosporin a Mitomycin c Cosyntropin | Low plasma renin; Low plasma and urinary aldosterone |
| ❖ Drugs interfering with angiotensin ii production Angiotensin ii converting enzyme inhibitors | High plasma renin; low plasma aldosterone; low angiotensin ii |
| PRIMARY DEFECTS IN ADRENAL SECRETION OF ALDOSTERONE | |
❖ Combined with defective cortisol synthesis
Congenital adrenal hyperplasia -Cholesterol desmolase deficiency (lipoid adrenal hyperplasia) -3β-hydroxysteroid dehydrogenase deficiency -21-hydroxylase deficiency -11β-hydroxylase deficiency Adrenoleukodystrophy, adrenomyeloneuropathy | Low plasma renin; low plasma aldosterone; low plasma cortisol High plasma deoxycorticosteorne |
| b) Acquired causes Autoimmune adrenal destruction -Addison's disease -Multiple autoimmune endocrinopathy Infectious adrenal destruction -Bacterial infection -Fungal infection Infiltration of adrenal glands -Amyloidosis -Hemochromatosis -Sarcoidosis Metastatic or infiltrative malignant disease Bilateral adrenalectomy Drug induced -Mitotane -Aminoglutethimide -Torilostane -Ketoconazole | Low plasma renin; low plasma aldosterone; low plasma cortisol |
❖ Isolated deficiency of aldosterone secretion
-Corticosterone methyloxidase type i (cmo i) deficiency -Corticosterone methyloxidase type ii (cmo ii) deficiency | High plasma renin; low plasma aldosterone Normal plasma 18-hydroxycorticosterone/aldosterone ratio High plasma 18-hydroxycorticosterone/aldosterone ratio |
-Sepsis -Pneumonia -Peritonitis -Cholangitis -Liver failure After removal of mineralocorticoid secreting adrenal tumor Discontinuation of agents with mineralocorticod activity Heparin or chlorbutol administration | Low plasma aldosterone concentration; inappropriate elevated plasma renin |
| DEFECTIVE ALDOSTERONE ACTION | |
| ❖ Pseudohypoaldosteronism (pha) type 1 Renal (autosomal dominant pha) Systemic pha (autosomal recessive pha) ❖ Secondary pseudohypoaldosteronism Associated with urinary tract infection Associated with medication that blocks epithelial sodium channel (enac) -Amiloride -Triamterene -Trimethoprim -Pentamidine Administration of aldosterone antagonists -Spironolactone -Progesterone -17-hydroxyprogesterone -Synthetic progestin Drugs that may lead to aldosterone resistance -Caludinerin inhibitor (cyclosporin a, tacrolimus) | High plasma renin; high plasma and urinary aldosterone |
From: Aldosterone Deficiency and Resistance
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