Physio --- 21 beta OHlyase deficiency - studyingmle2010

[ArchivalUser]

according to Dr. Kudrath video lectures, he said

in 21 beta OHlyase deficiency,
increase ACTH but decrease 11 deoxycortisone. Thus, no salt & water retention & decrease Blood Pressure. Therefore, renal compenstaion occur. It'll stimulate renin & increase Angiotensin II & increase Aldosterone. But in kaplan, it says decrease aldosterone.

I agreed with him the following two. Please let me know which one is right in 21 beta OHlyase deficiency (increase aldosterone or decrease aldosterone). Please explain me!!!!

in 11 beta OHlyase deficiency,
increase ACTH but increase 11 deoxycortisone. Thus, salt & water retention & increase BP. Therefore, renal compenstaion occur. It'll inhibit renin & decrease Angiotensin II & decrease Aldosterone.

in 17 alpha OHlyase deficiency,
increase ACTH but increase 11 deoxycortisone. Thus, salt & water retention & increase BP. Therefore, renal compenstaion occur. It'll inhibit renin & decrease Angiotensin II & decrease Aldosterone.

[ArchivalUser]

AgII acts distal to 21 beta hydroxylase to increase aldosterone synthesis and secretion. Therefore, with a proximal block, this effect cannot be of any significance. there is thus salt wasting and consequently hypotension. However, The RAAS is going to be activated, high levels of AgII would be present but not high levels of aldosterone.

[ArchivalUser]

AgII acts distal to 21 beta hydroxylase to increase aldosterone synthesis and secretion. Therefore, with a proximal block, this effect cannot be of any significance. there is thus salt wasting and consequently hypotension. However, The RAAS is going to be activated, high levels of AgII would be present but not high levels of aldosterone.

[ArchivalUser]

21 b hydroxylase def. causes def of the the pathway of synthesis of aldosterone , in other words 11 deoxycortisone is deficient and aldosterone itself is def, becuz the pathway itself is not working , so no matter how much renin , angiotensin 1 and 11 is stimulating the zona glomerulosa , u can't sunthesize aldosterone . u will have absolute hupotension

in 11 b hydroxylase def. , again u can't synthesize aldosterone but u have increased the other minor mineralocorticoid which will be increased enough to cause salt and water retention to cause hypertension , hypertension theoritically will cause low renin angiotensin 11 and should lead to low aldosterone but guess what , u CAN'T synthesis aldosterone any way and u will continue to synthesize the minor mineralocorticoid because of increased ACTH and hyperplastic adrenals

bottom line in both defiencies u have low aldosterone becuz the pathway leading all the way to aldosterone synthesis is defective but in 21 b hydro . def. u have low minor mineralocorticoids as well so hypotension occurs but in 11 b hydro def. u have high high minor mineralocorticoid so hypertension occurs

[ArchivalUser]

Thank you, usmle11 & moka.