What is the role of edema in primary aldosteronism?

Updated: Mar 24, 2020
  • Author: Gabriel I Uwaifo, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Answer

It is important to note that primary aldosteronism in and of itself is typically not associated with edema, despite the volume-expanded state associated with it. The lack of edema results from spontaneous natriuresis and diuresis (called the "aldosterone escape") that occurs in patients with primary aldosteronism and that appears to be mediated by atrial natriuretic peptide (ANP). [17, 18] Of note, this effect is probably based on the activation of the apical ATP/UTP/P2Y2 receptor system (at the connecting tubule/collecting duct level), leading to increased presentation of sodium, which, in turn, induces closure of the epithelial sodium channel (ENaC), with resultant decrease in sodium reabsorption (ie, enhanced natriuresis). [19] Hence, the finding of significant edema in patients who are presumed to have aldosteronism suggests either that a wrong diagnosis has been made or that associated complications, such as renal or cardiac failure, are present.


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