Mineralocorticoid excess

Question 1

eitology

Answer 1

• most common cause: primary aldosteronism > excess aldosterone production by adrenal zone glomerulosa.
• bilateral micro nodular hyperplasia is more common than unilateral adrenal adenomas.

Question 2

common cause for aldosterone producing adrenal adenoma

Answer 2

somatic mutation in channels and enzymes responsible for increasing Na and Ca influx in adrenal zone glomerulosa
germ line mutation - bilateral macro nodular adrenal hyperplasia
rare - prmary aldosteronism is caused by an adrenocortical carcinoma.
benign adenomas are usually <2mm in dameter

Question 3

Glucocorticoid remediable aldosteronism (GRA)

Answer 3

chimeric gene resulting from CYP11B1 and CYP11B2 involved in GC and MC synthesis.
Aldosterone production is regulated by ACTH rather than by renin.
associated with early onset hypertension and stroke.

Question 4

primary aldosteronism

Answer 4

• Adrenal (Conn’s) adenoma - mutation in the potassium channel, voltage gated Ca channel
• bilateral (micro nodular) adrenal hyperplasia: autonomous aldosterone access
• glucocorticoid remediable hyperaldosteronism

Question 5

other causes (rare)

Answer 5

• syndrome of apparent mineralocorticoid access (SAME)
• Cushing’s syndrome
• Glucocorticoid resistance
• adrenocortical carcinoma
• congenital adrenal hyperplasia
• progesterone induced hypertension
• riddles syndrome

Question 6

Metabolism of GC is decreased in

Answer 6

infancy, old age, pregnancy, CLD, hypothyroidism, anorexia nervosa, surgery, starvation, and other major physiologic stress

Question 7

catabolism of GC in increased in

Answer 7

Thyrotoxicosis