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. 2011 Oct;15 Suppl 4(Suppl4):S298-312.
doi: 10.4103/2230-8210.86972.

Mineralocorticoid hypertension

Vishal Gupta  1
Affiliations

Mineralocorticoid hypertension

Vishal Gupta. Indian J Endocrinol Metab. 2011 Oct.

Abstract

Hypertension affects about 10 - 25% of the population and is an important risk factor for cardiovascular and renal disease. The renin-angiotensin system is frequently implicated in the pathophysiology of hypertension, be it primary or secondary. The prevalence of primary aldosteronism increases with the severity of hypertension, from 2% in patients with grade 1 hypertension to 20% among resistant hypertensives. Mineralcorticoid hypertension includes a spectrum of disorders ranging from renin-producing pathologies (renin-secreting tumors, malignant hypertension, coarctation of aorta), aldosterone-producing pathologies (primary aldosteronism - Conns syndrome, familial hyperaldosteronism 1, 2, and 3), non-aldosterone mineralocorticoid producing pathologies (apparent mineralocorticoid excess syndrome, Liddle syndrome, deoxycorticosterone-secreting tumors, ectopic adrenocorticotropic hormones (ACTH) syndrome, congenitalvadrenal hyperplasia), and drugs with mineraocorticoid activity (locorice, carbenoxole therapy) to glucocorticoid receptor resistance syndromes. Clinical presentation includes hypertension with varying severity, hypokalemia, and alkalosis. Ratio of plasma aldosterone concentraion to plasma renin activity remains the best screening tool. Bilateral adrenal venous sampling is the best diagnostic test coupled with a CT scan. Treatment is either surgical (adrenelectomy) for unilateral adrenal disease versus medical therapy for idiopathic, ambiguous, or bilateral disease. Medical therapy focuses on blood pressure control and correction of hypokalemia using a combination of anti-hypertensives (calcium channel blockers, angiotensin converting enzyme inhibitors, or angiotensin receptor blockers) and potassium-raising therapies (mineralcorticoid receptor antagonist or potassium sparing diuretics). Direct aldosterone synthetase antagonists represent a promising future therapy.

Keywords: Aldosterone; aldosteronism; angiotensin; endocrine hypertension; hypertension; inherited hypertension; mineralocorticoid hypertension; renin; secondary hypertension.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Physiology of RAS
Figure 2
Figure 2
(a-d) Steroid Synthesis (Conversion of Cholesterol to Pregnenolone) in the adrenal cortex. Crucial enzymes are highlighted. Please refer to the text for clinical significance of each step
See this image and copyright information in PMC

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