Figure 128

Hyperaldosteronism and glucocorticoid-remediable aldosteronism. Hypertension can result from increased aldosterone or from increases in other closely related steroids derived from abnormal adrenal metabolism (11-^-hydroxylase deficiency and 17-|3-hydroxylase deficiency). The most common cause is an aldos-terone-producing adenoma; bilateral hyperplasia of the adrenal zona glomerulosa is the next most common cause. In glucocorti-coid-remediable aldosteronism, a DNA crossover mutation results in a chimeric gene in which aldosterone production is regulated by adrenocorticotropic hormone (ACTH). Increases in aldosterone also can result secondarily from any state of increased renin such as renal artery stenosis, which leads to increased circulating concentrations of angiotensin II and stimulation of aldosterone release [31]. MR—mineralocorticoid receptor; mRNA—messenger RNA.

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