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THE KIDNEY

Adrenocortical Adenoma¡ªHyperaldosteronism

In a 35-year-old woman an adenoma of her left adrenal gland produces high levels of aldosterone. This
woman experiences retention of Na+ by the kidneys (excretion < intake). However, after several days,
Na+ excretion increases to its previous level (excretion = intake). When the adenoma is surgically
removed, Na+ excretion increases (excretion > intake) but returns to its initial level over several days
(excretion = intake).

1. Delineate the mechanisms involved in these aldosterone-induced changes in Na+ excretion.

Aldosterone stimulates Na+ reabsorption in the collecting duct, which explains the reduction in Na+
secretion seen initially. As a result of the positive Na+ balance, the effective circulating blood volume is
increased. This in turn reduces proximal tubule reabsorption and enhances delivery of Na+ to the collecting
duct. Additionally, atrial natriuretic peptide (ANP) levels are increased, and its action on the collecting duct
to inhibit Na+ reabsorption, together with increased Na+ delivery, returns the Na+ excretion to its previous
level. A new steady state is reached in which ECV is expanded, and hence the body weight is increased.
With removal of the adenoma and return of the aldosterone levels to normal, the Na+ reabsorptive rate of
the collecting duct decreases. Because of the increased ECV and therefore enhanced Na+ delivery to the
collecting duct, the reabsorptive capacity of the collecting duct is overwhelmed, and Na + excretion
increases. After a period of negative Na+ balance, the ECV decreases back to normal. A new steady state
is reached, and the body weight returns to its original value as the extracellular fluid volume decreases.