Studies in Man on Hyper- and Hypoaldosteronism

Introduction The classification of clinical disorders associated with an abnormal secretion of aldosterone was clearly outlined by Conn.¹Primary hyperaldosteronism had been previously described by Conn²and secondary hyperaldosteronism in patients with nephrosis, congestive heart failure, and cirrhosis by Deming, Luetscher, and Curtis.³,⁴Although the syndrome of primary hypoaldosteronism had not been described, it was anticipated by Conn,¹and subsequently two patients have been reported as representing examples of this syndrome.⁵,⁶The exact pathophysiology of primary hypoaldosteronism is still in doubt.⁷ Although increased aldosterone secretion is not necessarily the primary cause of sodium and water retention in patients with edema, it is, in general, one constant finding in the chain of events leading to edema formation. Two groups of substances have been used to modify this aspect of edema; inhibitors of adrenal cortical activity⁸and peripheral antagonists of aldosterone.⁹The therapeutic usefulness of the adrenal inhibitor used most extensively,