This represents the most common cause of hypoaldosteronism. This is commonly seen in adult patients with diabetes mellitus and mild renal impairment who develop metabolic acidosis and hyperkalemia which is disproportionate to the level of renal impairment. This condition is also being seen with increased frequency in patients afflicted with AIDS.

In these patients both plasma renin and aldosterone levels fail to increase following sodium restriction and postural changes. Treatment entails instituting a low potassium diet and if this alone is ineffective, adding a loop diuretic to induce kaliuresis. If both of these measures fail, the patient may require replacement of the deficient aldosterone with the mineralocorticoid, fludrocortisone (0.1 mg PO either QD or QOD). Patients receiving fludrocortisone may experience sodium retention with resultant edema, making this a less attractive therapeutic option.