Aldosterone - old/new acquaintance in cardiology = Aldosteron - stari/novi znanec v kardiologiji
Šuštaršič, Miha ; Bunc, Matjaž
Aldosterone, a steroid hormone secreted by the zona glomerulosa cells of adrenal gland, was first discovered in 1953. Until recently its effects were contributed solely to its well known effects ...through mineralocorticoid receptors (MR) on blood pressure, extracellular volume and electrolyte balance. Two clinical trials, the Randomized ALdosterone Evaluation Study (RALES) and the EPlerenon HEart failure and Survival Study (EPHESUS), have shown that MR blockade reduces mortality and morbidity in heart failure on topof ACEI to extent which could not be attributed solely to renal mediated effects on blood pressure, extracellular volume and electrolyte balance. In this review we critically address the following questions: (1) How important is the extraadrenal aldosterone production and its effects on extrarenal tissue, (2) how important are aldosterones nongenomic effects on cardiovascular and renal system, (3) are there any other receptors than MRs that could be stimulated by aldosterone? The conclusions are that (1) the vastmajority of circulating aldosterone is synthesized in adrenal glands, but its synthesis in other tissues, although its importance is not clear, could not be denied and that aldosterone indeed displays many different effects on different tissues that lead to their destruction. (2) Aldosterone displays numerous nongenomic adverse effects on cardiovascular and renal tissue and notall could be blocked with conventional MR Mockers. (3) All effects of aldosterone cannot be explained through known MRs, but the evidence of yet unrecognized MR receptor is scarce. This raises the possibility that it would be better to block aldosterone's adverse actions at its synthesis rather than at its receptor.
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