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Hyperaldosteronism in pregnancy
University Hospital of Berne, Division of Nephrology and Hypertension,
Berne, Switzerland
* To whom correspondence should be addressed.
Aldosterone is a key regulator of electrolyte and water homeostasis and plays a
central role in blood pressure regulation. Hormonal changes during pregnancy, among
them increased progesterone and aldosterone production, lead to the required plasma
volume expansion of the maternal body as an accommodation mechanism for fetus
growth. This review discusses the regulation of aldosterone production by
aldosterone synthase (CYP11B2); the impact on aldosterone secretion due to the
presence of a chimeric gene originating from a crossover between
CYP11B1 and CYP11B2 in glucocorticoid remediable aldosteronism
(GRA) – the inherited form of hypertension; enhanced aldosterone
production in aldosterone-producing adenoma (APA); and idiopathic hyperaldosteronism
(IHA). Features of hyperaldosteronism are also found in patients with apparent
mineralocorticoid excess (AME), in which glucocorticoids exacerbate activation of
the mineralocorticoid receptor (MR) because of a defect in the
11 Key Words: aldosterone, pregnancy, CYP11B2, GRA, mineralocorticoid receptor
First published on January 26, 2009, doi:10.1177/1753944708100180 |
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-hydroxysteroid dehydrogenase type 2 enzyme. Regulation of aldosterone
production and tissue-specific activation of the mineralocorticoid receptor are
prerequisites for optimal control of body fluids and blood pressure during
pregnancy and contribute largely to the wellbeing of the mother-to-be.