Hypoaldosteronism differential diagnosis
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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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