HypoKalaemia

HypoK & Alkalosis

Hyperaldo and pseudohyperaldosteronism.

Aldosterone controls K & H secretion and NA reabsorbtion via the ENAC channel on the cortical collecting duct epithelial cells

Therefore , hyper/pseudo hyper looks like the opposite of taking Spironolactone

i.e. HypoK & Alkalosis & HTN

Obvious overlap here with the monogenic causes of HTN - info on both pages

Adrenal hyperfunction / primary hyperaldosteronism

including adrenal adenoma, adrenal hyperplasia, and adrenal carcinoma.

Syndrome of apparent mineralocorticoid excess

Liddles

Autosomal dominant Gain of function of ENAC

Licorice ingestion = Syndrome of Apparent Mineralocorticoid Excess

six tea bags of ‘Twinings Comforting’ liquorice tea dail

European licorice is worse than american stuff, more GZA

Remember, Aldosterone controls K & H secretion and NA reabsorbtion via the ENAC channel on the cortical collecting duct epithelial cells
Cortisol can also activate this but is converted to inactive cortisone by enzyme 11-beta-hydroxysteroid dehydrogenase type 2. phew
Unless licorice inactivates the enzyme first!
The compound in licorice that is responsible for this enzyme inhibitory activity is glycyrrhetinic acid, which also has some mild mineralocorticoid activity.
This is the same as syndrome of apparant mineralocorticoid excess = mutations in the 11-beta-hydroxysteroid dehydrogenase enzyme that prevent proper conversion of cortisol into cortisone.
The European Union’s scientific committee on food recommends a daily upper limit of 100 mg for glycyrrhizin6 which is present in approximately 50g liquorice (assuming a content of 0.2% glycyrrhizin)
11β-HSD2 can remain suppressed for 2 weeks or so after withdrawal of licorice, but the RAS axis can remain suppressed for months , perhaps 4
inhibition of 11β-HSD2 decreases the urinary ratio of cortisone metabolites to cortisol metabolites which is a diagnostic clue for this mechanism of secondary hypertension

Renal artery stenosis and renin secreting tumors.

elevated production and secretion of renin leading to hyperaldosteronism.

Renin:Aldosterone ratio

Liddle’s — low renin, low aldo (appropriate suppression in face of gained function) Licorice and SAME — low renin, low aldo ( body is responding appropriatly and shutting down in face of feedback) Renal artery stenosis and renin-secreting tumors — high renin, high aldo ( kidneys think blood flow is low) Adrenal hyperfunction — low renin, high aldo (appropriately suppressed renin)