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Exp Clin Endocrinol Diabetes 2023; 131(07/08): 386-393
DOI: 10.1055/a-2054-1062
Review

An Abbreviated History of Aldosterone Metabolism, Current and Future Challenges

Celso E Gomez-Sanchez
1   G.V. (Sonny) Montgomery VA Medical Center and Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, MS, United States of America
,
Elise P Gomez-Sanchez
1   G.V. (Sonny) Montgomery VA Medical Center and Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, MS, United States of America
› Author Affiliations Funding Information National Heart, Lung, and Blood Institute — http://dx.doi.org/10. 13039/100000050; HL144847; National Institutes of General Medical Sciences — U54 GM115428; USA Department of Veterans’ Affairs — BX00468
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Abstract

The initial isolation of adrenal steroids from large quantities of animal adrenals resulted in an amorphous fraction resistant to crystallization and identification and had potent effects on electrolyte transport. Aldosterone was eventually isolated and identified in the fraction and was soon shown to cause hypertension when in excess. The autonomous and excessive production of aldosterone, primary aldosteronism, is the most common cause of secondary hypertension. Aldosterone is metabolized in the liver and kidney, and its metabolites are conjugated with glucuronic acid for excretion. The most common liver metabolite is 3α,5β-tetrahydroaldosterone-3-glucuronide, while that of the kidney is aldosterone-18-oxo-glucuronide. In terms of their value, especially the aldosterone-18-oxo-glucuronide, is commonly used for the diagnosis of primary aldosteronism because they provide an integrated value of the total daily production of aldosterone. Conversion of aldosterone to 18-oxo-glucuronide is impeded by drugs, like some common non-steroidal anti-inflammatory drugs that compete for UDP-glucuronosyltransferase-2B7, the most important glucuronosyltransferase for aldosterone metabolism. Tetrahydroaldosterone is the most abundant metabolite and the most reliable for the diagnosis of primary aldosteronism, but it is not commonly measured.

Key words

GH Adrenal gland - Hormones - aldosterone - primary aldosteronism


Publication History

Received: 16 January 2023
Received: 02 March 2023

Accepted: 09 March 2023

Accepted Manuscript online:
14 March 2023

Article published online:
08 May 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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