Paediatrics: Mineralocorticoid excess
The principal mineralocorticoid secreted by the adrenal gland is aldosterone.
The principal mineralocorticoid secreted by the adrenal gland is aldoste-rone. Increased production may result from a primary defect of the adrenal gland (primary hyperaldosteronism) or from factors that activate the renin-angiotensin system (secondary hyperaldosteronism). Hypokalaemia and hypertension are typical features.
Characterized by hypokalaemia and hypertension. There is the suppression of the renin-angiotensin system with low plasma renin levels. Children may have no symptoms, the diagnosis is established after the incidental finding of hypertension. Chronic hypokalaemia may result in muscle weakness, fatigue, and poor growth.
Causes of primary hyperaldosteronism
- Bilateral adrenal hyperplasia
- Adrenal tumours
- Glucocorticoid-remediable hyperaldosteronism
This occurs when excess aldosterone production is secondary to elevated renin levels. Hypertension may or may not be present.
Causes of secondary hyperaldosteronism
Associated with hypertension
- Renovascular malformations/stenosis
- Primary hyperreninaemia
- Juxtaglomerular tumour
- Wilm’s tumour
- Post-renal transplantation
- Urinary tract obstruction
- Hepatic cirrhosis
- Congestive cardiac failure
- Nephrotic syndrome
- Bartter’s syndrome
- Anorexia nervosa
Syndrome of apparent mineralocorticoid excess: type 1 and type 2 variants