Figure 3: The Approach to Mineralocorticoid Excess Syndromes. See concept video above or at https://www.youtube.com/watch?v=db9v9kNIiXU. Evaluation of renin as suppressed or unsuppressed is often the first algorithmic step to determine whether the underlying pathophysiology is renin or AngII-dependent versus renin or AngII-independent. Renin-independent states (low renin) can be further characterized as having a relatively high aldosterone (primary aldosteronism) or a suppressed aldosterone (pseudo primary aldosteronism). High renin states represent secondary aldosteronism and may present with hypertension or normotension, depending on the nature of disease.