Explanation of the pseudohypoaldosteronism (PHA)-stress syndrome with an artificial aldosterone receptor model.

A receptor for aldosterone was studied in the cytosol of rectal mucosa of two sisters (M.A., M.B.) with the clinical manifestations of pseudohypoaldosteronism (PHA). Compared to age matched controls the patients showed a decreased affinity for aldosterone (M.A. Kd1: 0.18 nM, Kd2: 4.55 nM; Nmax1: 0.185 fmol/mg cytosol protein (CP), Nmax2: 3.12 fmol/mg CP, respectively). In an attempt to find an explanation for the phenomenon of stress-induced electrolyte imbalance in PHA patients an experimental set up was designed, using aldosterone antibody material as artificial aldosterone receptor. Specific binding was evaluated in addition with and without a 25-100-fold molar excess of dexamethasone (DEX) in order to overcome the glucocorticoid affinity of the aldosterone receptor, a phenomenon proposed to be the cause for the severe consequences of stress in some patients with PHA. The aldosterone antiserum showed two binding sites, similar to the natural receptor (Kd1: 0.15 nM, Kd2: 1.30 nM; Nmax: 30 fmol/mg CP and 130 fmol/mg CP, respectively). Under the influence of DEX the high affinity binding site (Kd1) was occupied by the glucocorticoidanalogon (Kd: 1.30 nM; Nmax: 125 fmol/mg CP). In conclusion, in stress situations, with increased quantities of glucocorticoid circulating, the high affinity binding site of the aldosterone receptor might be occupied by the glucocorticoids, while the low affinity binding site in PHA patients might not have sufficient binding capacity to maintain the electrolyte balance.