Aldosteronism revisited: Perspectives on less well-recognized actions of aldosterone

Aldosterone is a mineralocorticoid with protean actions in both epithelial and nonepithelial cells. These include endocrine properties of circulating aldosterone that promote Na+ resorption at the expense of well-recognized K+ excretion and less well-recognized Mg2+ excretion in classic target tissues: kidneys, colon, and sweat and salivary glands. The regulation of adrenal aldosterone secretion by (Mg2+)(o) is also less well appreciated. More recently recognized endocrine actions of aldosterone include induction of Mg2+ efflux in exchange for Na+ in such nonepithelial cells as peripheral-blood mononuclear cells and influence on epithelial cells of the choroid plexus, where aldosterone alters the composition of cerebrospinal fluid that contributes to blood-pressure regulation. An association between primary aldosteronism and idiopathic intracranial hypertension has recently been reported. Extraadrenal steroidogenesis with de novo aldosterone production by the cardiovasculature, where its auto-/paracrine properties may contribute to tissue repair at sites of injury, has been observed. These less well-recognized actions of aldosterone have led to a revival of interest in how this steroid molecule contributes to the pathophysiology of various clinical disorders.