The contention has also been made that angiotensin peptides of the non-canonical branch of the RAS might regulate adrenocortical function and evidence exists that Ang II can also regulate the production of glucocorticoids. Therefore, the regulation of aldosterone secretion by angiotensin peptides plays a role that needs to be appreciated in order to fully understand the pathophysiology of hyperaldosteronism.

Furthermore, there are numerous other conditions, as congestive heart failure, liver cirrhosis, nephrotic syndrome, primary reninism, Bartter’s and Gitelman’s syndromes and renovascular hypertension, which are usually referred to as secondary aldosteronism, where hyperaldosteronism is driven by activation of the renin angiotensin system (RAS). Secretion of aldosterone occurring in a fashion apparently autonomous from angiotensin (Ang) II and in excess of what needed to preserve body fluids volume and maintain blood pressure, is a key feature of primary aldosteronism, the most common curable cause of human arterial hypertension. For example, a secretion of aldosterone in excess of the physiological need is a feature of primary (essential) hypertension associated with overweight and obesity, which involves a multitude of patients affected by the so called “metabolic syndrome”.

A full appreciation of the pathophysiology of these disorders, therefore, requires a deep understanding of the regulation of adrenocortical function.Įxcess production of the main mineralocorticoid hormone aldosterone is involved in several human diseases where it plays a substantial role in causing hypertension-mediated organ damage, cardiovascular events, and deaths. Hence, an altered regulation in the production of these hormones is involved in the pathophysiology of multiple diseases including high blood pressure, Cushing’s and Addison’s syndromes, and virilization. The adrenal cortex plays a key role in the regulation of metabolism, salt and water homeostasis and sex differentiation by synthesizing glucocorticoid, mineralocorticoid and androgen hormones.

Adrenal cortex function