The Aldosterone Crisis Hypothesis – “Covid Syndrome”
The RAAS helps maintain interstitial fluid homeostasis and tissue perfusion and has a central role in the cardiovascular injury through inflammatory mechanisms. Aldosterone is a powerful pro-inflammatory steroid hormone and aldosterone-mediated stress is directly implicated in obesity, hypertension, cardiovascular, renal and respiratory diseases, diabetes, cancer and inflammation; matching the profile of COVID-19-susceptible patients. (5,6) RAAS-blocking pharmaceuticals have shown enough promise in COVID-19 to encourage further study.
This author hypothesizes that acute ACE2 depletion in COVID-19 induces acute-on-chronic RAAS stress mediated by excessive Ang II and aldosterone levels, which together activate the severe inflammatory and oxidative stress responses that contribute to the spectrum of organ dysfunctions, “Covid Syndrome”, encountered by these patients. Blocking aldosterone production and activity, alone or in concert with other RAAS suppressing/counteractive treatments that correct the susceptible host derangement, may provide a logical, safe and immediately available treatment approach.