This card is testing a different enzyme. It is logical that a lack of 11ß-hydroxylase will lead to ↓ aldosterone and there likely is another card testing this. This card is meant to highlight the fact that aldosterone will be ↓ even if the adrenal enzyme pathway is shunting only to production of mineralocorticoids (as with a 17α-hydroxylase deficiency). It will still appear as if the patient has ↑↑ aldosterone, but their lab value will be surprisingly low. Instead, DOC will be ↑ and has some mineralocorticoid activity, which is responsible for negative feedback to ↓ aldosterone but also to maintain the hypertension/hyponatremia/hyperkalemia that the patient will exhibit.
that kinda makes sense? But the sketchy image on that card very clearly says “17-hydroxylase deficiency leads to increased aldosterone”. So does that mean there would be increased aldosterone PRODUCTION in the adrenals due to increased ACTH and a shunted pathway, but decreased aldosterone SECRETION due renin inhibition from DOC. That would imply both 11β and 17α show symptoms of mineralocorticoid excess, so both present with hypertension and hypokalemia?