21 versus 11 beta hydroxylase deficiencies
Why do we have hypotension and increased angiotensin II in 21 b OH def
Why do we have hypertesion and decreased angiotensin II in 11 b OH def
The answer lies in 11-deoxycorticosterone:
this compound which is a mineralocorticoid is present in the granulosa pathway column and comes from Progesterone by activity of 21 and is metabolized to corticosterone by 11.
in 21 def this compound is not produced so less mineralocorticoid activity and so hyponatremia and hyperkalemia and hypotension (typical presentation in adrenogenital syndrome babies) and reactive increase in the renin and ATII secretion
while in 11 def this compound will accumilate so excessive mineralocorticoid so hypertension and the reactive decrease in renin and ATII