RENIN-INDEPENDENT HYPERMINERALOCORTICOIDISM

Although renin-independent hypermineralocorticoidism is an uncommon fo rm of hypertension, its diagnosis provides the clinician with a unique opportunity in the field of hypertension that is, to vender a surgica l cure or to achieve a dramatic pharmacologic response in the treatmen t of hypertension. Primary aldosteronism is the most common form of re nin-independent hypermineralocorticoidism. The plasma aldosterone conc entration to plasma renin ratio is an excellent screening test for pri mary aldosteronism, the diagnosis of which should be confirmed by demo nstrating unsuppressible urine or plasma levels of aldosterone. The su btype of primary aldosteronism dictates the most appropriate therapy. Computerized imaging of the adrenal glands and adrenal venous sampling assist in distinguishing unilateral (requiring surgical treatment) fr om bilateral (requiring pharmacologic treatment) adrenal disease. The forms of mineralocorticoid excess considered in the hypokalemic hypert ensive patient with low aldosterone values include congenital adrenal hyperplasia (11 beta-hydroxylase and 17 alpha-hydroxylase deficiencies ), deoxycorticosterone-producing tumor Cushing's syndrome, primary cor tisol resistance, and 11 beta-hydroxysteroid dehydrogenase deficiency (apparent mineralocorticoid excess syndrome). The 11 beta-hydroxystero id dehydrogenase deficiency may be congenital or acquired (for example , ingestion of licorice or carbenoxolone).