Mineralocorticoid cardiovascular effects

CARDIOVASCULAR SYSTEM The most striking cardiovascular effects of corticosteroids result from mineralocorticoid-induced changes in renal Na+ excretion, as is evident in primary aldosteronism. The resultant hypertension can lead to a diverse group of adverse effects on the cardiovascular system (see Chapter 32). Consistent with the known actions of mineralocorticoids in the kidney, restriction of dietary Na can lower the blood pressure considerably in mineralocorticoid excess. 

When given in larger than physiologic amounts, steroids such as cortisone and hydrocortisone, which have mineralocorticoid effects in addition to glucocorticoid effects, cause some sodium and fluid retention and loss of potassium. In patients with normal cardiovascular and renal function, this leads to a hypokalemic, hypochloremic alkalosis and eventually to a rise in blood pressure. In patients with hypoproteinemia, renal disease, or liver disease, edema may also occur. In patients with heart disease, even small degrees of sodium retention may lead to heart failure. These effects can be minimized by using synthetic non-salt-retaining steroids, sodium restriction, and judicious amounts of potassium supplements. 

Mihailidou AS, Funder JW. Nongenomic effects of mineralocorticoid receptor activation in the cardiovascular system. Steroids. 2005 70 347-351. 

The heart, as an endocrine organ itself, secretes the atrial natriuretic peptide, which has several important influences on the cardiovascular system. In addition to atrial natriuretic peptide, catecholamines, thyroid hormones, mineralocorticoids, sex steroids, and angiotensin II are other hormones also known to exert their effects on the cardiovascular functions and blood pressure. Hormones regulate the contraction and dilatation of the vascular bed. They may also affect the contraction of other smooth muscles other than the vascular smooth muscle. Oxytocin stimulates contraction of the myoepithelium in the mammary gland that is necessary for milk ejection. 

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