Originally Posted by griffinannie
And what would be symptoms, if any?
This is a cut and paste from a site.
Aldosterone is a steroid secreted by the cortex of the adrenal gland. It is
the most potent hormone regulating the body's electrolyte balance.
Aldosterone acts directly on the kidney to decrease the rate of sodium-ion excretion (with accompanying retention of water), and to increase the rate of potassium-ion excretion. The secretion of aldosterone appears to be regulated by two mechanisms. First, the concentration of sodium ions may be a factor since increased rates of aldosterone secretion are found when dietary sodium is severely limited. Second, reduced blood flow to the kidney stimulates certain kidney cells to secrete the proteolytic enzyme renin, which converts the inactive angiotensinogen globulin in the blood into angiotensin I. Another enzyme then converts angiotensin I into angiotensin II, its active form. This peptide
, in turn, stimulates the
secretion of aldosterone by the adrenal cortex. Pathologically elevated
aldosterone secretion with concomitant excessive retention of salt and water often results in EDEMA.
Renin should always be tested with aldosterone. Only way to know if primary (hyperreninemic hypoaldosteronism) or secondary (hyporeninemic hypoaldosteronism) hypoaldosteronism. If aldosterone is low, renin high, that matches with primary AI. If aldosterone low, renin low, that matches with what those with secondary AI usually get. (In over 3 years, I've not seen a secondary with high renin. update Aug 06, ran across someone who's cortisol stim tripled, very low DHEA and low aldosterone and HIGH renin, so looks like it can happen, but looks to me to be very rare). I don't know why renin goes low in secondary AI.
Hypothyroidism can mask hypoaldosteronism. If you are on proper cortisol replacement and Armour (happens usually with less than 3 grains) is causing your pulse to go into the 90's or higher (I've seen some that will reach 120 or more before treating their hypoaldosteronism), then definately test
aldosterone, renin, sodium and potassium and get opinions of these tests.
There is a wide belief in the medical community that hypoaldosterone only happens to those with primary adrenal insufficiency or Addison's. This is totally false as I have seen many with secondary AI test
low for both aldosterone and renin. What is actually true is that many diagnosed with secondary AI don't get tested and diagnosed with hypoaldosteronism when they actually have it and need the Florinef and salt intake. The ranges for renin and aldosterone are very flawed, but among the least flawed of all hormone tests. Most people are in range on both tests.
For florinef to work properly, salt must be ingested (teaspoon a day or more depending on the individual) since florinef is only half as potent has human aldosterone.
Florinef has very potentially potent glucocorticoid properties, though most people benefit very slighty, if at all. A small percentage get the full potency. For those that experiance the full potency, 100 mcg has glucocorticoid potency of 10 mg of Cortef/hydrocortisone, 2 1/2 mg of prednisone and 2 mg of methylprednisone. Again, most do not experiance the glucocorticoid potency potential of Florinef. I don't know why this is. From my experiance, I'd say 1 in 20 get some noticeable glucocorticoid effect and I'd estimate up to 1 in 40 get full glucorticoid potency and have to lower their glucocorticoid (ie, hydrocortisone, prendnisone) to balance.
Florinef does have suppressive effect on aldosterone production and if glucocorticoid property is experianced, then florinef may also suppress natural cortisol.
Deficiencies of aldosterone include low to very low blood pressure and high pulse due to lower blood volume from lack of sodium, excessive urination, desire to eat salt, dizziness or lightheadedness on standing, and palpitations, a pale, hollow face, a drowsy, absent-minded look, Severe cases may lead to high potassium and low sodium in blood tests. When the adrenals are not making aldosterone, renin, (a kidney enzyme), increases, but low aldosterone can also be caused by lack of renin enzyme. Without enough renin, angiotensin I and II can't be broken down into enough aldosterone and this is called hyporeninemic hypoaldosteronism.
What side effects florinef can cause?
Although side effects from fludrocortisone are not common, they can occur. Tell your doctor if any of these symptoms are severe or do not go away:
increased blood pressure
Water retention (can cause excessive weight gain)-swollen face (may be reddish), lower legs, or ankles
stomach irritation, vomiting, black or tarry stool
insomnia , restlessness
acne, skin rash, easy bruising, increased hair growth
irregular or absent menstrual periods
cold or infection that lasts a long time
Hypopituitary Issues Moderator - I'm not a doc, just giving you my knowledge and experiance. Always do your own research of anything someone tells you. That pic is what I looked like in Sept 03, I look nothing like that now.