Hypoaldosteronism differential diagnosis: Difference between revisions
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* Various subtypes of hypoaldosteronism can be differentiated on the basis of [[Plasma renin activity|plasma renin activity (PRA)]], serum [[aldosterone]], and serum [[cortisol]]. These tests are performed after maintaining an upright position for three hours. Under normal conditions, maintaining an upright position for long duration activates the neuro-hormonal regulation by the [[kidneys]] which leads to increased [[renin]] and [[aldosterone]] release. | * Various subtypes of hypoaldosteronism can be differentiated on the basis of [[Plasma renin activity|plasma renin activity (PRA)]], serum [[aldosterone]], and serum [[cortisol]]. These tests are performed after maintaining an upright position for three hours. Under normal conditions, maintaining an upright position for long duration activates the neuro-hormonal regulation by the [[kidneys]] which leads to increased [[renin]] and [[aldosterone]] release. | ||
* The following table distinguishes among various subtypes of hypoaldosteronism: | * The following table distinguishes among various subtypes of hypoaldosteronism: | ||
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{| | {| | ||
! style="background: #4479BA; color: #FFFFFF; text-align: center " - | Disorder | ! style="background: #4479BA; color: #FFFFFF; text-align: center " - | Disorder | ||
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| style="background: #F5F5F5; text-align: center "|Normal/↓ | | style="background: #F5F5F5; text-align: center "|Normal/↓ | ||
| style="background: #F5F5F5; text-align: center "|Normal | | style="background: #F5F5F5; text-align: center "|Normal | ||
<br> | |||
* Hypoaldosteronism must be differentiated from other diseases that cause [[hypotension]] and [[muscle weakness]] such as [[Addison's disease]], [[myopathies]], [[celiac disease]], [[Peutz-Jeghers syndrome]], [[anorexia nervosa]], [[Syndrome of inappropriate antidiuretic hormone|syndrome of inappropriate anti-diuretic hormone (SIADH)]], [[neurofibromatosis]], [[porphyria cutanea tarda]], salt-depletion [[nephritis]] and [[bronchogenic carcinoma]].<ref name="pmid16483775">{{cite journal |vauthors=Selva-O'Callaghan A, Labrador-Horrillo M, Gallardo E, Herruzo A, Grau-Junyent JM, Vilardell-Tarres M |title=Muscle inflammation, autoimmune Addison's disease and sarcoidosis in a patient with dysferlin deficiency |journal=Neuromuscul. Disord. |volume=16 |issue=3 |pages=208–9 |year=2006 |pmid=16483775 |doi=10.1016/j.nmd.2006.01.005 |url=}}</ref><ref name="pmid11427410">{{cite journal |vauthors=Kumar V, Rajadhyaksha M, Wortsman J |title=Celiac disease-associated autoimmune endocrinopathies |journal=Clin. Diagn. Lab. Immunol. |volume=8 |issue=4 |pages=678–85 |year=2001 |pmid=11427410 |pmc=96126 |doi=10.1128/CDLI.8.4.678-685.2001 |url=}}</ref><ref name="pmid9496878">{{cite journal |vauthors=Adams R, Hinkebein MK, McQuillen M, Sutherland S, El Asyouty S, Lippmann S |title=Prompt differentiation of Addison's disease from anorexia nervosa during weight loss and vomiting |journal=South. Med. J. |volume=91 |issue=2 |pages=208–11 |year=1998 |pmid=9496878 |doi= |url=}}</ref><ref name="pmid6414566">{{cite journal |vauthors=Lever EG, Stansfeld SA |title=Addison's disease, psychosis, and the syndrome of inappropriate secretion of antidiuretic hormone |journal=Br J Psychiatry |volume=143 |issue= |pages=406–10 |year=1983 |pmid=6414566 |doi= |url=}}</ref><ref name="pmid13356214">{{cite journal |vauthors=BELL R, PATTEE CJ |title=Addison's disease associated with neurofibromatosis |journal=Can Med Assoc J |volume=75 |issue=5 |pages=415–7 |year=1956 |pmid=13356214 |pmc=1823303 |doi= |url=}}</ref> | * Hypoaldosteronism must be differentiated from other diseases that cause [[hypotension]] and [[muscle weakness]] such as [[Addison's disease]], [[myopathies]], [[celiac disease]], [[Peutz-Jeghers syndrome]], [[anorexia nervosa]], [[Syndrome of inappropriate antidiuretic hormone|syndrome of inappropriate anti-diuretic hormone (SIADH)]], [[neurofibromatosis]], [[porphyria cutanea tarda]], salt-depletion [[nephritis]] and [[bronchogenic carcinoma]].<ref name="pmid16483775">{{cite journal |vauthors=Selva-O'Callaghan A, Labrador-Horrillo M, Gallardo E, Herruzo A, Grau-Junyent JM, Vilardell-Tarres M |title=Muscle inflammation, autoimmune Addison's disease and sarcoidosis in a patient with dysferlin deficiency |journal=Neuromuscul. Disord. |volume=16 |issue=3 |pages=208–9 |year=2006 |pmid=16483775 |doi=10.1016/j.nmd.2006.01.005 |url=}}</ref><ref name="pmid11427410">{{cite journal |vauthors=Kumar V, Rajadhyaksha M, Wortsman J |title=Celiac disease-associated autoimmune endocrinopathies |journal=Clin. Diagn. Lab. Immunol. |volume=8 |issue=4 |pages=678–85 |year=2001 |pmid=11427410 |pmc=96126 |doi=10.1128/CDLI.8.4.678-685.2001 |url=}}</ref><ref name="pmid9496878">{{cite journal |vauthors=Adams R, Hinkebein MK, McQuillen M, Sutherland S, El Asyouty S, Lippmann S |title=Prompt differentiation of Addison's disease from anorexia nervosa during weight loss and vomiting |journal=South. Med. J. |volume=91 |issue=2 |pages=208–11 |year=1998 |pmid=9496878 |doi= |url=}}</ref><ref name="pmid6414566">{{cite journal |vauthors=Lever EG, Stansfeld SA |title=Addison's disease, psychosis, and the syndrome of inappropriate secretion of antidiuretic hormone |journal=Br J Psychiatry |volume=143 |issue= |pages=406–10 |year=1983 |pmid=6414566 |doi= |url=}}</ref><ref name="pmid13356214">{{cite journal |vauthors=BELL R, PATTEE CJ |title=Addison's disease associated with neurofibromatosis |journal=Can Med Assoc J |volume=75 |issue=5 |pages=415–7 |year=1956 |pmid=13356214 |pmc=1823303 |doi= |url=}}</ref> | ||
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{| | {| | ||
|- style="background: #4479BA; color: #FFFFFF; text-align: center;" | |- style="background: #4479BA; color: #FFFFFF; text-align: center;" | ||
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|'''Other symptoms''' | |'''Other symptoms''' | ||
|'''Hyponatremia''' | |'''Hyponatremia''' | ||
| ' Cortisol level |Cortisol levels | |'''[[Cortisol level |Cortisol levels]]''' | ||
|'''Other labs''' | |'''Other labs''' | ||
|- style="background: #DCDCDC; padding: 5px; text-align: center;" | |- | ||
|Hypoaldosteronism | | style="background: #DCDCDC; padding: 5px; text-align: center;"|Hypoaldosteronism | ||
| + | | style="background: #F5F5F5; padding: 5px; text-align: center;"|+ | ||
| - | | style="background: #F5F5F5; padding: 5px; text-align: center;"| - | ||
| +/- | | style="background: #F5F5F5; padding: 5px; text-align: center;"| +/- | ||
| + | | style="background: #F5F5F5; padding: 5px; text-align: center;"| + | ||
| - | | style="background: #F5F5F5; padding: 5px; text-align: center;"| - | ||
| +/- | | style="background: #F5F5F5; padding: 5px; text-align: center;"| +/- | ||
|[[Muscle]] [[tenderness]] | | style="background: #F5F5F5; padding: 5px; text-align: center;"|[[Muscle]] [[tenderness]] | ||
| +/- | | style="background: #F5F5F5; padding: 5px; text-align: center;"| +/- | ||
|Normal | | style="background: #F5F5F5; padding: 5px; text-align: center;"|Normal | ||
| | | style="background: #F5F5F5; padding: 5px; text-align: center;"| | ||
| | | style="background: #F5F5F5; padding: 5px; text-align: center;"| | ||
|- style="background: #DCDCDC; padding: 5px; text-align: center;" | |- | ||
|Addison's disease | | style="background: #DCDCDC; padding: 5px; text-align: center;"|Addison's disease | ||
| + | | style="background: #F5F5F5; padding: 5px; text-align: center;"| + | ||
| + | | style="background: #F5F5F5; padding: 5px; text-align: center;"| + | ||
| + | | style="background: #F5F5F5; padding: 5px; text-align: center;"| + | ||
| + | | style="background: #F5F5F5; padding: 5px; text-align: center;"| + | ||
| + | | style="background: #F5F5F5; padding: 5px; text-align: center;"| + | ||
| + | | style="background: #F5F5F5; padding: 5px; text-align: center;"| + | ||
| | | style="background: #F5F5F5; padding: 5px; text-align: center;"| | ||
| + | | style="background: #F5F5F5; padding: 5px; text-align: center;"| + | ||
|Low | | style="background: #F5F5F5; padding: 5px; text-align: center;"|Low | ||
| | | style="background: #F5F5F5; padding: 5px; text-align: center;"| | ||
|[[ACTH stimulation test]] | | style="background: #F5F5F5; padding: 5px; text-align: center;"|[[ACTH stimulation test]] | ||
|- style="background: #DCDCDC; padding: 5px; text-align: center;" | |- | ||
|Salt-depletion [[nephritis]] | | style="background: #DCDCDC; padding: 5px; text-align: center;"|Salt-depletion [[nephritis]] | ||
| + | | style="background: #F5F5F5; padding: 5px; text-align: center;"| + | ||
|[[Flank pain]] | | style="background: #F5F5F5; padding: 5px; text-align: center;"|[[Flank pain]] | ||
| - | | style="background: #F5F5F5; padding: 5px; text-align: center;"| - | ||
| - | | style="background: #F5F5F5; padding: 5px; text-align: center;"| - | ||
| - | | style="background: #F5F5F5; padding: 5px; text-align: center;"| - | ||
| - | | style="background: #F5F5F5; padding: 5px; text-align: center;"| - | ||
| | | style="background: #F5F5F5; padding: 5px;"| | ||
* [[Fever]] | * [[Fever]] | ||
* [[Dysuria]] | * [[Dysuria]] | ||
* [[Pyuria]] | * [[Pyuria]] | ||
* [[Oliguria]] | * [[Oliguria]] | ||
| + | | style="background: #F5F5F5; padding: 5px; text-align: center;"| + | ||
|Elevated | | style="background: #F5F5F5; padding: 5px; text-align: center;"|Elevated | ||
|<15:1 [[BUN-to-creatinine ratio|BUN:CR]] | | style="background: #F5F5F5; padding: 5px; text-align: center;"|<15:1 [[BUN-to-creatinine ratio|BUN:CR]] | ||
| | | style="background: #F5F5F5; padding: 5px; text-align: center;"| | ||
|- style="background: #DCDCDC; padding: 5px; text-align: center;" | |- | ||
|[[Myopathies]] | | style="background: #DCDCDC; padding: 5px; text-align: center;"|[[Myopathies]] | ||
([[polymyositis]], | ([[polymyositis]], | ||
hereditary myopathies) | hereditary myopathies) | ||
| - | | style="background: #F5F5F5; padding: 5px; text-align: center;"| - | ||
| - | | style="background: #F5F5F5; padding: 5px; text-align: center;"| - | ||
| - | | style="background: #F5F5F5; padding: 5px; text-align: center;"| - | ||
| + | | style="background: #F5F5F5; padding: 5px; text-align: center;"| + | ||
| - | | style="background: #F5F5F5; padding: 5px; text-align: center;"|- | ||
|Heliotrope rash and | | style="background: #F5F5F5; padding: 5px; text-align: center;"|Heliotrope rash and | ||
Gottron's sign | Gottron's sign | ||
| | | style="background: #F5F5F5; padding: 5px;"| | ||
* [[Muscle]] [[tenderness]] | * [[Muscle]] [[tenderness]] | ||
| - | | style="background: #F5F5F5; padding: 5px; text-align: center;"| - | ||
|Normal | | style="background: #F5F5F5; padding: 5px; text-align: center;"|Normal | ||
| - | | style="background: #F5F5F5; padding: 5px; text-align: center;"| - | ||
|[[Muscle biopsy]] | | style="background: #F5F5F5; padding: 5px; text-align: center;"|[[Muscle biopsy]] | ||
|- style="background: #DCDCDC; padding: 5px; text-align: center;" | |- | ||
|[[Anorexia nervosa]] | | style="background: #DCDCDC; padding: 5px; text-align: center;"|[[Anorexia nervosa]] | ||
| + | | style="background: #F5F5F5; padding: 5px; text-align: center;"| + | ||
| - | | style="background: #F5F5F5; padding: 5px; text-align: center;"| - | ||
| + | | style="background: #F5F5F5; padding: 5px; text-align: center;"| + | ||
| + | | style="background: #F5F5F5; padding: 5px; text-align: center;"| + | ||
| + | | style="background: #F5F5F5; padding: 5px; text-align: center;"| + | ||
| - | | style="background: #F5F5F5; padding: 5px; text-align: center;"| - | ||
| | | style="background: #F5F5F5; padding: 5px;"| | ||
* Distorted [[body image]] | * Distorted [[body image]] | ||
* [[Oligomenorrhea]] | * [[Oligomenorrhea]] | ||
| - | | style="background: #F5F5F5; padding: 5px; text-align: center;"| - | ||
|Elevated | | style="background: #F5F5F5; padding: 5px; text-align: center;"|Elevated | ||
| - | | style="background: #F5F5F5; padding: 5px; text-align: center;"| - | ||
|[[Psychiatric]] condition | | style="background: #F5F5F5; padding: 5px; text-align: center;"|[[Psychiatric]] condition | ||
|- style="background: #DCDCDC; padding: 5px; text-align: center;" | |- | ||
|[[Celiac disease]] | | style="background: #DCDCDC; padding: 5px; text-align: center;"|[[Celiac disease]] | ||
| - | | style="background: #F5F5F5; padding: 5px; text-align: center;"| - | ||
| + | | style="background: #F5F5F5; padding: 5px; text-align: center;"| + | ||
| + | | style="background: #F5F5F5; padding: 5px; text-align: center;"| + | ||
| - | | style="background: #F5F5F5; padding: 5px; text-align: center;"| - | ||
| - | | style="background: #F5F5F5; padding: 5px; text-align: center;"| - | ||
|[[Dermatitis herpetiformis]] | | style="background: #F5F5F5; padding: 5px; text-align: center;"|[[Dermatitis herpetiformis]] | ||
| | | style="background: #F5F5F5; padding: 5px;"| | ||
* [[Greasy stools]] | * [[Greasy stools]] | ||
* Increased [[fecal fat]] | * Increased [[fecal fat]] | ||
| - | | style="background: #F5F5F5; padding: 5px; text-align: center;"| - | ||
|Normal | | style="background: #F5F5F5; padding: 5px; text-align: center;"|Normal | ||
| - | | style="background: #F5F5F5; padding: 5px; text-align: center;"| - | ||
|Abnormal [[small bowel]] [[biopsy]] | | style="background: #F5F5F5; padding: 5px; text-align: center;"|Abnormal [[small bowel]] [[biopsy]] | ||
|- style="background: #DCDCDC; padding: 5px; text-align: center;" | |- | ||
|[[Syndrome of inappropriate antidiuretic hormone|Syndrome of inappropriate anti-diuretic hormone]] | | style="background: #DCDCDC; padding: 5px; text-align: center;"|[[Syndrome of inappropriate antidiuretic hormone|Syndrome of inappropriate anti-diuretic hormone]] | ||
[[Syndrome of inappropriate antidiuretic hormone|(SIADH)]] | [[Syndrome of inappropriate antidiuretic hormone|(SIADH)]] | ||
| - | | style="background: #F5F5F5; padding: 5px; text-align: center;"| - | ||
| - | | style="background: #F5F5F5; padding: 5px; text-align: center;"| - | ||
| - | | style="background: #F5F5F5; padding: 5px; text-align: center;"| - | ||
| - | | style="background: #F5F5F5; padding: 5px; text-align: center;"| - | ||
| - | | style="background: #F5F5F5; padding: 5px; text-align: center;"| - | ||
| - | | style="background: #F5F5F5; padding: 5px; text-align: center;"| - | ||
| - | | style="background: #F5F5F5; padding: 5px; text-align: center;"| - | ||
| + | | style="background: #F5F5F5; padding: 5px; text-align: center;"| + | ||
|Normal | | style="background: #F5F5F5; padding: 5px; text-align: center;"|Normal | ||
| | | style="background: #F5F5F5; padding: 5px;"| | ||
* Decreased [[osmolality]] | * Decreased [[osmolality]] | ||
* Euvolemia | * Euvolemia | ||
* [[Sodium]] in [[urine]] typically >20 mEq/L | * [[Sodium]] in [[urine]] typically >20 mEq/L | ||
|Water deprivation test | | style="background: #F5F5F5; padding: 5px; text-align: center;"|Water deprivation test | ||
|- style="background: #DCDCDC; padding: 5px; text-align: center;" | |- | ||
|[[Neurofibromatosis]] | | style="background: #DCDCDC; padding: 5px; text-align: center;"|[[Neurofibromatosis]] | ||
| - | | style="background: #F5F5F5; padding: 5px; text-align: center;"| - | ||
| - | | style="background: #F5F5F5; padding: 5px; text-align: center;"| - | ||
| + | | style="background: #F5F5F5; padding: 5px; text-align: center;"| + | ||
| + | | style="background: #F5F5F5; padding: 5px; text-align: center;"| + | ||
| - | | style="background: #F5F5F5; padding: 5px; text-align: center;"| - | ||
|Axillary- and inguinal-area freckling | | style="background: #F5F5F5; padding: 5px; text-align: center;"|Axillary- and inguinal-area freckling | ||
| | | style="background: #F5F5F5; padding: 5px;"| | ||
* Occasional development of peripheral [[sarcomas]] | * Occasional development of peripheral [[sarcomas]] | ||
* May have overgrowth of [[Subcutaneous tissue|subcutaneous tissues]] | * May have overgrowth of [[Subcutaneous tissue|subcutaneous tissues]] | ||
| - | | style="background: #F5F5F5; padding: 5px; text-align: center;"| - | ||
| - | | style="background: #F5F5F5; padding: 5px; text-align: center;"| - | ||
| - | | style="background: #F5F5F5; padding: 5px; text-align: center;"| - | ||
|[[Skin biopsy|Biopsy of skin tissue]] | | style="background: #F5F5F5; padding: 5px; text-align: center;"|[[Skin biopsy|Biopsy of skin tissue]] | ||
|- style="background: #DCDCDC; padding: 5px; text-align: center;" | |- | ||
|[[Peutz-Jeghers syndrome]] | | style="background: #DCDCDC; padding: 5px; text-align: center;"|[[Peutz-Jeghers syndrome]] | ||
| | | style="background: #F5F5F5; padding: 5px; text-align: center;"| | ||
| + | | style="background: #F5F5F5; padding: 5px; text-align: center;"| + | ||
| | | style="background: #F5F5F5; padding: 5px; text-align: center;"| | ||
| | | style="background: #F5F5F5; padding: 5px; text-align: center;"| | ||
| | | style="background: #F5F5F5; padding: 5px; text-align: center;"| | ||
| + | | style="background: #F5F5F5; padding: 5px; text-align: center;"| + | ||
| | | style="background: #F5F5F5; padding: 5px;"| | ||
* Melanotic [[hyperpigmentation]] of the [[skin]] and [[mucous membranes]] | * Melanotic [[hyperpigmentation]] of the [[skin]] and [[mucous membranes]] | ||
| - | | style="background: #F5F5F5; padding: 5px; text-align: center;"| - | ||
|Normal | | style="background: #F5F5F5; padding: 5px; text-align: center;"|Normal | ||
| | | style="background: #F5F5F5; padding: 5px; text-align: center;"| | ||
|Colonic [[imaging]] showing the [[Small intestine|small intestinal]] [[polyps]] | | style="background: #F5F5F5; padding: 5px; text-align: center;"|Colonic [[imaging]] showing the [[Small intestine|small intestinal]] [[polyps]] | ||
|- style="background: #DCDCDC; padding: 5px; text-align: center;" | |- | ||
|[[Porphyria cutanea tarda]] | | style="background: #DCDCDC; padding: 5px; text-align: center;"|[[Porphyria cutanea tarda]] | ||
| - | | style="background: #F5F5F5; padding: 5px; text-align: center;"| - | ||
| + | | style="background: #F5F5F5; padding: 5px; text-align: center;"| + | ||
| - | | style="background: #F5F5F5; padding: 5px; text-align: center;"| - | ||
| - | | style="background: #F5F5F5; padding: 5px; text-align: center;"| - | ||
| - | | style="background: #F5F5F5; padding: 5px; text-align: center;"| - | ||
|[[Blisters]] on sun-exposed sites | | style="background: #F5F5F5; padding: 5px; text-align: center;"|[[Blisters]] on sun-exposed sites | ||
| | | style="background: #F5F5F5; padding: 5px;"| | ||
* Associated [[liver disease]] (usually [[hepatitis C]]) | * Associated [[liver disease]] (usually [[hepatitis C]]) | ||
* [[Hypertrichosis]] | * [[Hypertrichosis]] | ||
| - | | style="background: #F5F5F5; padding: 5px; text-align: center;"| - | ||
|Normal or elevated | | style="background: #F5F5F5; padding: 5px; text-align: center;"|Normal or elevated | ||
|High level of [[porphyrins]] in the [[urine]] | | style="background: #F5F5F5; padding: 5px; text-align: center;"|High level of [[porphyrins]] in the [[urine]] | ||
| | | style="background: #F5F5F5; padding: 5px; text-align: center;"| | ||
|- style="background: #DCDCDC; padding: 5px; text-align: center;" | |- | ||
|[[Bronchogenic carcinoma]] | | style="background: #DCDCDC; padding: 5px; text-align: center;"|[[Bronchogenic carcinoma]] | ||
| - | | style="background: #F5F5F5; padding: 5px; text-align: center;"| - | ||
| - | | style="background: #F5F5F5; padding: 5px; text-align: center;"| - | ||
| + | | style="background: #F5F5F5; padding: 5px; text-align: center;"| + | ||
| +/- | | style="background: #F5F5F5; padding: 5px; text-align: center;"| +/- | ||
| - | | style="background: #F5F5F5; padding: 5px; text-align: center;"| - | ||
| + | | style="background: #F5F5F5; padding: 5px; text-align: center;"| + | ||
| | | style="background: #F5F5F5; padding: 5px; text-align: center;"| | ||
* [[Cough]] | * [[Cough]] | ||
* [[Dyspnea]] | * [[Dyspnea]] | ||
* [[Hemoptysis]] | * [[Hemoptysis]] | ||
| - | | style="background: #F5F5F5; padding: 5px; text-align: center;"| - | ||
|Elevated | | style="background: #F5F5F5; padding: 5px; text-align: center;"|Elevated | ||
|Increased [[ACTH]] and | | style="background: #F5F5F5; padding: 5px; text-align: center;"|Increased [[ACTH]] and | ||
[[Hypokalemia]] | [[Hypokalemia]] | ||
|[[Cytological]] or [[histological]] [[evidence]] of [[lung cancer]] in [[sputum]], [[pleural fluid]], or tissue | | style="background: #F5F5F5; padding: 5px; text-align: center;"|[[Cytological]] or [[histological]] [[evidence]] of [[lung cancer]] in [[sputum]], [[pleural fluid]], or tissue | ||
|} | |} | ||
Revision as of 18:53, 11 October 2017
Hypoaldosteronism Microchapters |
Diagnosis |
---|
Treatment |
Case Studies |
Hypoaldosteronism differential diagnosis On the Web |
American Roentgen Ray Society Images of Hypoaldosteronism differential diagnosis |
Risk calculators and risk factors for Hypoaldosteronism differential diagnosis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Akshun Kalia M.B.B.S.[2]
Overview
Hypoaldosteronism must be differentiated from other diseases that cause hypotension and muscle weakness such as Addison's disease, salt-depletion nephritis, myopathies, celiac disease, Peutz-Jeghers syndrome, anorexia nervosa, syndrome of inappropriate anti-diuretic hormone (SIADH), neurofibromatosis, porphyria cutanea tarda, and bronchogenic carcinoma. In addition, measurement of plasma renin activity (PRA), serum aldosterone, and serum cortisol is used to differentiate among various subtypes of hypoaldosteronism.
Differentiating Hypoaldosteronism from other Diseases
- Various subtypes of hypoaldosteronism can be differentiated on the basis of plasma renin activity (PRA), serum aldosterone, and serum cortisol. These tests are performed after maintaining an upright position for three hours. Under normal conditions, maintaining an upright position for long duration activates the neuro-hormonal regulation by the kidneys which leads to increased renin and aldosterone release.
- The following table distinguishes among various subtypes of hypoaldosteronism:
Disorder | Plasma ReninActivity | Plasma Aldosterone | Plasma cortisol | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Hyporeninemic hypoaldosteronism | Low | Low | Normal | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Hypereninemic hypoaldosteronism | Increased | Low | Normal/↓ | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Primary adrenal insufficiency | High | Low | Low | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pseudohypoaldosteronism type I | High | High | Normal | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pseudohypoaldosteronism type II | Normal/↓ | Normal/↓ | Normal
References
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