What is the pathophysiology of hyperaldosteronism in infancy?

Updated: Oct 19, 2018
  • Author: George P Chrousos, MD, FAAP, MACP, MACE, FRCP(London); Chief Editor: Robert P Hoffman, MD  more...
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Answer

The mineralocorticoid dependency of sodium reabsorption is increased during infancy and childhood, peaking in the neonatal period before decreasing progressively with advancing age. This increase occurs because the reabsorption of sodium and water by the proximal tubule is least efficient in early life, resulting in an increased sodium and water load at the level of the distal renal tubule.

Because sodium and water resorption from the distal tubule is mediated by the R-A-A axis, the PRA is approximately 10-fold to 20-fold higher in a newborn infant than in an adult. Consequently, neonates show relative increases in aldosterone production rates (>300 µg/m2/day vs 50 µg/m2/day in an adult) and plasma aldosterone concentrations (80 pg/dL vs 16 pg/dL). These increases in early life explain why young infants exhibit profound clinical symptoms of hyperaldosteronism that gradually improve with advancing age.


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