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].
 
Hypoaldosteronism must be differentiated from other diseases that cause [[hypotension]], [[skin pigmentation]], and [[abdominal pain]] 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>
 
 
 
{| 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;"
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="2" |Disease
! rowspan="2" |Disease
! colspan="7" |Differentiating symptoms
! colspan="7" |Differentiating symptoms
! colspan="3" |Differentiating laboratory findings
! colspan="3" |Differentiating laboratory findings
! rowspan="2" |Gold standard test
! rowspan="2" |Gold standard test
|-style="background: #4479BA; color: #FFFFFF; text-align: center;"
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
|'''Hypotension'''
|'''Hypotension'''
|'''Abdominal pain'''
|'''Abdominal pain'''
Line 82: Line 60:
|'''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;"
|- style="background: #DCDCDC; padding: 5px; text-align: center;"
|Addison's disease
|Addison's disease
| +
| +
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|
|
|[[ACTH stimulation test]]
|[[ACTH stimulation test]]
|-style="background: #DCDCDC; padding: 5px; text-align: center;"
|- style="background: #DCDCDC; padding: 5px; text-align: center;"
|[[Myopathies]]
|[[Myopathies]]
([[polymyositis]],  
([[polymyositis]],  
Line 115: Line 93:
| -
| -
|[[Muscle biopsy]]
|[[Muscle biopsy]]
|-style="background: #DCDCDC; padding: 5px; text-align: center;"
|- style="background: #DCDCDC; padding: 5px; text-align: center;"
|[[Celiac disease]]
|[[Celiac disease]]
| -
| -
Line 130: Line 108:
| -
| -
|Abnormal [[small bowel]] [[biopsy]]
|Abnormal [[small bowel]] [[biopsy]]
|-style="background: #DCDCDC; padding: 5px; text-align: center;"
|- style="background: #DCDCDC; padding: 5px; text-align: center;"
|[[Syndrome of inappropriate antidiuretic hormone|Syndrome of inappropriate anti-diuretic hormone]]
|[[Syndrome of inappropriate antidiuretic hormone|Syndrome of inappropriate anti-diuretic hormone]]
[[Syndrome of inappropriate antidiuretic hormone|(SIADH)]]
[[Syndrome of inappropriate antidiuretic hormone|(SIADH)]]
Line 147: Line 125:
* [[Sodium]] in [[urine]] typically >20 mEq/L
* [[Sodium]] in [[urine]] typically >20 mEq/L
|Water deprivation test
|Water deprivation test
|-style="background: #DCDCDC; padding: 5px; text-align: center;"
|- style="background: #DCDCDC; padding: 5px; text-align: center;"
|[[Neurofibromatosis]]
|[[Neurofibromatosis]]
| -
| -
Line 162: Line 140:
| -
| -
|[[Skin biopsy|Biopsy of skin tissue]]
|[[Skin biopsy|Biopsy of skin tissue]]
|-style="background: #DCDCDC; padding: 5px; text-align: center;"
|- style="background: #DCDCDC; padding: 5px; text-align: center;"
|[[Peutz-Jeghers syndrome]]
|[[Peutz-Jeghers syndrome]]
|
|
Line 176: Line 154:
|
|
|Colonic [[imaging]] showing the [[Small intestine|small intestinal]] [[polyps]]
|Colonic [[imaging]] showing the [[Small intestine|small intestinal]] [[polyps]]
|-style="background: #DCDCDC; padding: 5px; text-align: center;"
|- style="background: #DCDCDC; padding: 5px; text-align: center;"
|[[Porphyria cutanea tarda]]
|[[Porphyria cutanea tarda]]
| -
| -
Line 191: Line 169:
|High level of [[porphyrins]] in the [[urine]]
|High level of [[porphyrins]] in the [[urine]]
|
|
|-style="background: #DCDCDC; padding: 5px; text-align: center;"
|- style="background: #DCDCDC; padding: 5px; text-align: center;"
|Salt-depletion [[nephritis]]
|Salt-depletion [[nephritis]]
| +
| +
Line 208: Line 186:
|<15:1 [[BUN-to-creatinine ratio|BUN:CR]]
|<15:1 [[BUN-to-creatinine ratio|BUN:CR]]
|
|
|-style="background: #DCDCDC; padding: 5px; text-align: center;"
|- style="background: #DCDCDC; padding: 5px; text-align: center;"
|[[Bronchogenic carcinoma]]
|[[Bronchogenic carcinoma]]
| -
| -
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[[Hypokalemia]]
[[Hypokalemia]]
|[[Cytological]] or [[histological]] [[evidence]] of [[lung cancer]] in [[sputum]], [[pleural fluid]], or tissue
|[[Cytological]] or [[histological]] [[evidence]] of [[lung cancer]] in [[sputum]], [[pleural fluid]], or tissue
|-style="background: #DCDCDC; padding: 5px; text-align: center;"
|- style="background: #DCDCDC; padding: 5px; text-align: center;"
|[[Anorexia nervosa]]
|[[Anorexia nervosa]]
| +
| +

Revision as of 19:29, 22 August 2017

Hypoaldosteronism Microchapters

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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].

Hypoaldosteronism must be differentiated from other diseases that cause hypotension, skin pigmentation, and abdominal pain such as Addison's disease, 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

(polymyositis,

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

(SIADH)

- - - - - - - + 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

Hypokalemia

Cytological or histological evidence of lung cancer in sputum, pleural fluid, or tissue
Anorexia nervosa + - + + + - - Elevated - Psychiatric condition

References

  1. ↑ 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.
  2. ↑ 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.

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