Can having chronically low ADH cause a compensating increase in aldosterone?

Question

If a person is not able to make or release enough ADH, can aldosterone production increase to compensate? If so, would this scenario make one more prone to androgenic effects?

Answer 1

Great question!

The answer is yes and actually provides a lot of insight into the nature of the physiology of water retention and hormone production.

First let's state the obvious:

ADH (aka vasopressin) - Water deprivation (or low blood pressure) stimulates the release of ADH by the posterior pituitary gland. ADH targets the kidneys to increased retaining of water and salts.

Aldosterone - low blood pressure leads to the secretion of by the adrenal cortex which leads to the increased retaining of water and sodium via the RAAS (renin-angiotensin-aldosterone system)

Thinking it through:

If an individual had low ADH, this would lead to the increased loss of water through the renal system (more urination). Loss of water will decrease the blood pressure (and consequently the pressure of blood to the kidneys). and therefore, activate the RAAS.

Low blood pressure activates RAAS and leads to the increased secretion of aldosterone.

Now as the second part of your question: will increased aldosterone lead to androgenic effects?

Let's look at the synthesis of aldosterone:

It is produced in the adrenal cortex from cholesterol. When aldosterone is produced in increased amounts, it can lead to hyperaldosteronism - low potassium levels, muscle weakness/spasms.

Here's the interesting part, the compensatory increase in aldostorone production also increases the breakdown of cholesterol. This actually deprives the adrenal cortex of cholesterol. If more cholesterol is used to make aldosterone, less is available to make DHEA, testosterone, and estrogen.

Conclusion: Low ADH -> high Aldosterone -> low testosterone production by the adrenal cortex

One wrinkle: in males, testosterone production is mostly unaffected because their testes produce most of their testosterone.

Here is a great resource about the RAAS system: https://teachmephysiology.com/urinary-system/regulation/the-renin-angiotensin-aldosterone-system/

Hope this answers your question and let me know if I can explain more!