Hypoaldosteronism differential diagnosis: Difference between revisions
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*As [disease name] manifests in a variety of clinical forms, differentiation must be established in accordance with the particular subtype. [Subtype name 1] must be differentiated from other diseases that cause [clinical feature 1], such as [differential dx1] and [differential dx2]. In contrast, [subtype name 2] must be differentiated from other diseases that cause [clinical feature 2], such as [differential dx3] and [differential dx4]. | *As [disease name] manifests in a variety of clinical forms, differentiation must be established in accordance with the particular subtype. [Subtype name 1] must be differentiated from other diseases that cause [clinical feature 1], such as [differential dx1] and [differential dx2]. In contrast, [subtype name 2] must be differentiated from other diseases that cause [clinical feature 2], such as [differential dx3] and [differential dx4]. | ||
{| class="wikitable" | |||
!Type of | |||
Adrenal insufficiency | |||
!Skin Pigmentation | |||
!ACTH | |||
!Normal ACTH | |||
|- | |||
|Addison disease | |||
| + | |||
|>60 ng/mL | |||
| rowspan="2" |5-30 ng/mL | |||
|- | |||
|Secondary / | |||
tertiary adrenal insufficiency | |||
| - | |||
|<5 ng/mL | |||
|} | |||
Addison's disease must be differentiated from other diseases that cause hypotension, skin pigmentation, and abdominal pain such as myopathies, celiac disease, [[Peutz-Jeghers syndrome]] ,[[anorexia nervosa]], 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> | |||
{| | |||
|-style="background: #4479BA; color: #FFFFFF; text-align: center;" | |||
! rowspan="2" |Disease | |||
! colspan="7" |Differentiating symptoms | |||
! colspan="3" |Differentiating laboratory findings | |||
! rowspan="2" |Gold standard test | |||
|-style="background: #4479BA; color: #FFFFFF; text-align: center;" | |||
|'''Hypotension''' | |||
|'''Abdominal pain''' | |||
|'''Anorexia/''' | |||
'''weight loss''' | |||
|'''Muscle weakness''' | |||
|'''Hypoglycemia''' | |||
|'''Skin pigmentation''' | |||
|'''Other symptoms''' | |||
|'''Hyponatremia''' | |||
|'''Cortisol level|Cortisol levels''' | |||
|'''Other labs''' | |||
|-style="background: #DCDCDC; padding: 5px; text-align: center;" | |||
|Addison's disease | |||
| + | |||
| + | |||
| + | |||
| + | |||
| + | |||
| + | |||
| | |||
| - | |||
|Low | |||
| | |||
|[[ACTH stimulation test]] | |||
|-style="background: #DCDCDC; padding: 5px; text-align: center;" | |||
|[[Myopathies]] | |||
([[polymyositis]], | |||
hereditary myopathies) | |||
| - | |||
| - | |||
| - | |||
| + | |||
| - | |||
|Heliotrope rash and | |||
Gottron's sign | |||
| | |||
* [[Muscle]] [[tenderness]] | |||
| - | |||
|Normal | |||
| - | |||
|[[Muscle biopsy]] | |||
|-style="background: #DCDCDC; padding: 5px; text-align: center;" | |||
|[[Celiac disease]] | |||
| - | |||
| + | |||
| + | |||
| - | |||
| - | |||
|[[Dermatitis herpetiformis]] | |||
| | |||
* [[Greasy stools]] | |||
* Increased [[fecal fat]] | |||
| - | |||
|Normal | |||
| - | |||
|Abnormal [[small bowel]] [[biopsy]] | |||
|-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)]] | |||
| - | |||
| - | |||
| - | |||
| - | |||
| - | |||
| - | |||
| - | |||
| + | |||
|Normal | |||
| | |||
* Decreased [[osmolality]] | |||
* Euvolemia | |||
* [[Sodium]] in [[urine]] typically >20 mEq/L | |||
|Water deprivation test | |||
|-style="background: #DCDCDC; padding: 5px; text-align: center;" | |||
|[[Neurofibromatosis]] | |||
| - | |||
| - | |||
| + | |||
| + | |||
| - | |||
|Axillary- and inguinal-area freckling | |||
| | |||
* Occasional development of peripheral [[sarcomas]] | |||
* May have overgrowth of [[Subcutaneous tissue|subcutaneous tissues]] | |||
| - | |||
| - | |||
| - | |||
|[[Skin biopsy|Biopsy of skin tissue]] | |||
|-style="background: #DCDCDC; padding: 5px; text-align: center;" | |||
|[[Peutz-Jeghers syndrome]] | |||
| | |||
| + | |||
| | |||
| | |||
| | |||
| + | |||
| | |||
* Melanotic [[hyperpigmentation]] of the [[skin]] and [[mucous membranes]] | |||
| - | |||
|Normal | |||
| | |||
|Colonic [[imaging]] showing the [[Small intestine|small intestinal]] [[polyps]] | |||
|-style="background: #DCDCDC; padding: 5px; text-align: center;" | |||
|[[Porphyria cutanea tarda]] | |||
| - | |||
| + | |||
| - | |||
| - | |||
| - | |||
|[[Blisters]] on sun-exposed sites | |||
| | |||
* Associated [[liver disease]] (usually [[hepatitis C]]) | |||
* [[Hypertrichosis]] | |||
| - | |||
|Normal or elevated | |||
|High level of [[porphyrins]] in the [[urine]] | |||
| | |||
|-style="background: #DCDCDC; padding: 5px; text-align: center;" | |||
|Salt-depletion [[nephritis]] | |||
| + | |||
|[[Flank pain]] | |||
| - | |||
| - | |||
| - | |||
| - | |||
| | |||
* [[Fever]] | |||
* [[Dysuria]] | |||
* [[Pyuria]] | |||
* [[Oliguria]] | |||
| + | |||
|Elevated | |||
|<15:1 [[BUN-to-creatinine ratio|BUN:CR]] | |||
| | |||
|-style="background: #DCDCDC; padding: 5px; text-align: center;" | |||
|[[Bronchogenic carcinoma]] | |||
| - | |||
| - | |||
| + | |||
| - | |||
| - | |||
| + | |||
| | |||
* [[Cough]] | |||
* [[Dyspnea]] | |||
* [[Hemoptysis]] | |||
| - | |||
|Elevated | |||
|Increased [[ACTH]] and | |||
[[Hypokalemia]] | |||
|[[Cytological]] or [[histological]] [[evidence]] of [[lung cancer]] in [[sputum]], [[pleural fluid]], or tissue | |||
|-style="background: #DCDCDC; padding: 5px; text-align: center;" | |||
|[[Anorexia nervosa]] | |||
| + | |||
| - | |||
| + | |||
| + | |||
| + | |||
| - | |||
| | |||
* Distorted [[body image]] | |||
* [[Oligomenorrhea]] | |||
| - | |||
|Elevated | |||
| - | |||
|[[Psychiatric]] condition | |||
|} | |||
==References== | ==References== |
Revision as of 19:10, 22 August 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
OR
[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].
Differentiating X from other Diseases
Disorder | Plasma ReninActivity | Plasma Aldosterone | Plasma cortisol |
---|---|---|---|
Hyporeninemic hypoaldosteronism | Low | Low | Normal |
Hypereninemic hypoaldosteronism | Increased | Low | Normal |
Primary adrenal insufficiency | High | Low | Low |
Pseudohypoaldosteronism type 1 | High | High | Normal |
- [Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
- [Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].
- As [disease name] manifests in a variety of clinical forms, differentiation must be established in accordance with the particular subtype. [Subtype name 1] must be differentiated from other diseases that cause [clinical feature 1], such as [differential dx1] and [differential dx2]. In contrast, [subtype name 2] must be differentiated from other diseases that cause [clinical feature 2], such as [differential dx3] and [differential dx4].
Type of
Adrenal insufficiency |
Skin Pigmentation | ACTH | Normal ACTH |
---|---|---|---|
Addison disease | + | >60 ng/mL | 5-30 ng/mL |
Secondary /
tertiary adrenal insufficiency |
- | <5 ng/mL |
Addison's disease must be differentiated from other diseases that cause hypotension, skin pigmentation, and abdominal pain such as myopathies, celiac disease, Peutz-Jeghers syndrome ,anorexia nervosa, syndrome of inappropriate anti-diuretic hormone (SIADH), neurofibromatosis, porphyria cutanea tarda, salt-depletion nephritis and bronchogenic carcinoma.[1][2]
Disease | Differentiating symptoms | Differentiating laboratory findings | Gold standard test | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Hypotension | Abdominal pain | Anorexia/
weight loss |
Muscle weakness | Hypoglycemia | Skin pigmentation | Other symptoms | Hyponatremia | Cortisol levels | Other labs | ||
Addison's disease | + | + | + | + | + | + | - | Low | ACTH stimulation test | ||
Myopathies
hereditary myopathies) |
- | - | - | + | - | Heliotrope rash and
Gottron's sign |
- | Normal | - | Muscle biopsy | |
Celiac disease | - | + | + | - | - | Dermatitis herpetiformis |
|
- | Normal | - | Abnormal small bowel biopsy |
Syndrome of inappropriate anti-diuretic hormone | - | - | - | - | - | - | - | + | Normal |
|
Water deprivation test |
Neurofibromatosis | - | - | + | + | - | Axillary- and inguinal-area freckling |
|
- | - | - | Biopsy of skin tissue |
Peutz-Jeghers syndrome | + | + |
|
- | Normal | Colonic imaging showing the small intestinal polyps | |||||
Porphyria cutanea tarda | - | + | - | - | - | Blisters on sun-exposed sites |
|
- | Normal or elevated | High level of porphyrins in the urine | |
Salt-depletion nephritis | + | Flank pain | - | - | - | - | + | Elevated | <15:1 BUN:CR | ||
Bronchogenic carcinoma | - | - | + | - | - | + | - | Elevated | Increased ACTH and | Cytological or histological evidence of lung cancer in sputum, pleural fluid, or tissue | |
Anorexia nervosa | + | - | + | + | + | - |
|
- | Elevated | - | Psychiatric condition |
References
- ↑ Selva-O'Callaghan A, Labrador-Horrillo M, Gallardo E, Herruzo A, Grau-Junyent JM, Vilardell-Tarres M (2006). "Muscle inflammation, autoimmune Addison's disease and sarcoidosis in a patient with dysferlin deficiency". Neuromuscul. Disord. 16 (3): 208–9. doi:10.1016/j.nmd.2006.01.005. PMID 16483775.
- ↑ Kumar V, Rajadhyaksha M, Wortsman J (2001). "Celiac disease-associated autoimmune endocrinopathies". Clin. Diagn. Lab. Immunol. 8 (4): 678–85. doi:10.1128/CDLI.8.4.678-685.2001. PMC 96126. PMID 11427410.