Hypoaldosteronism (patient information)
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Hypoaldosteronism |
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Hypoaldosteronism On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Hypoaldosteronism is a condition characterized by the shortage (deficiency) or impaired function of a hormone called aldosterone. Aldosterone is an important hormone in human body which maintains acid-base (electrolytes) balance and also regulates the blood pressure. The kidneys in our body sense decreased blood pressure and blood sodium level and release the hormone renin in an effort to bring them (blood pressure and sodium level) back to normal level. The hormone renin further leads to formation of aldosterone through a series of biochemical reactions. Hypoaldosteronism may be described as hyporeninemic or hyperreninemic depending on renin levels. Hyporeninemic hypoaldosteronism occurs when there is decreased production of aldosterone due to decreased production of renin . Affected individuals typically have kidney (renal) disease due to various conditions, such as diabetes, interstitial nephritis, or multiple myeloma. Hyperreninemic hypoaldosteronism occurs when there is a problem with the production of aldosterone, but renin is produced normally by the kidneys. Common causes of this form of hypoaldosteronism are medications (ACE inhibitors), lead poisoning, severe illness, and aldosterone enzyme defect.
What are the Symptoms of Hypoaldosteronism?
Common symptoms of hypoaldosteronism include:[1][2][3][4]
- Chronic fatigue
- Low blood pressure
- Lightheadedness
- Palpitations
- Muscle weakness
- Anorexia
- Weight loss
- Salt craving
- Dizziness
What Causes Hypoaldosteronism?
Common cause of hypoaldosteronism include disorders of kidney and adrenal glands. Some drugs which can block the action of hormone renin or aldosterone may also lead to hypoaldosteronism. Any chronic kidney disease may lead to inadequate production of renin, similarly any adrenal gland disorders may lead to decrease production of aldosterone. Drugs leading top hypoaldosteronism include ACE inhibitor, ARBs, calcineurin inhibitors, nitric oxide and heparin.
Who is at risk for Hypoaldosteronism?
Common risk factors in the development of hypoaldosteronism include:[5][6][7]
- Diabetes mellitus
- Sickle cell anemia
- HIV
- Graves' disease
- Hypoparathyroidism
- Hypopituitarism
- Myasthenia gravis
- Pernicious anemia
- Vitiligo
Diagnosis
There is no established criteria for the diagnosis of hypoaldosteronism. Patients with a positive history of low blood pressure (hypotension), muscle weakness and fatigue should raise suspicion for hypoaldosteronism. These patients should first be tested for serum potassium levels and later for plasma renin activity (PRA), serum aldosterone, and serum cortisol. Asymptomatic hypoaldosteronism can also be discovered on routine laboratory evaluations.
When to Seek Urgent Medical Care?
It is important to seek medical care if you show signs of any of the symptoms associated with hypoaldosteronism. This is especially important if you experience any of the symptoms of low blood pressure, muscle fatigue and altered mental status, as this can be fatal if not treated immediately.
Treatment Options
Treatment for hypoaldosteronism depends on the underlying condition. Affected individuals are often advised to follow a low-potassium diet with liberal sodium intake. People with hypoaldosteronism should typically avoid ACE inhibitors and potassium-sparing diuretics. Individuals with hypoaldosteronism and a deficiency of adrenal glucocorticoid hormones are usually given fludrocortisone. People with hyporeninemic hypoaldosteronism are frequently given furosemide to correct hyperkalemia
Where to find Medical Care for Hypoaldosteronism?
Medical care for (disease name) can be found here.
Prevention
- Effective measures for the prevention of hypoaldosteronism include:[8][9][10]
- Low potassium intake
- Salt intake of 4gm/day
- Avoid drugs affecting the renin angiotensin aldosterone system (RAAS) such as:
What to Expect (Outlook/Prognosis)?
- Depending on the extent of the blood potassium level and underlying kidney or adrenal gland condition at the time of diagnosis, the prognosis of hypoaldosteronism may vary.[11][12][13]
- Prognosis is generally good for patients of hypoaldosteronism who receive treatment.
- Untreated patients risk having increased blood potassium level which leads to abnormal electrical conduction in heart that can be fatal.
- Patient having underlying renal disease or diabetic nephropathy may progresses to end stage stage renal disease.
Possible Complications
- Common complications of hypoaldosteronism include:[11]
- Increased blood potassium level (Hyperkalemia)
- Decreased blood pressure (Hypotension )
- Dehydration (Hypovolemia)
- Low blood sodium level (Hyponatremia)
Sources
http://www.nlm.nih.gov/medlineplus/ency/article/000434.htm
- ↑ Rodríguez Soriano J (2002). "Renal tubular acidosis: the clinical entity". J. Am. Soc. Nephrol. 13 (8): 2160–70. PMID 12138150.
- ↑ Tan SY, Burton M (1981). "Hyporeninemic hypoaldosteronism. An overlooked cause of hyperkalemia". Arch. Intern. Med. 141 (1): 30–3. PMID 7004370.
- ↑ Sarkar SB, Sarkar S, Ghosh S, Bandyopadhyay S (2012). "Addison's disease". Contemp Clin Dent. 3 (4): 484–6. doi:10.4103/0976-237X.107450. PMC 3636818. PMID 23633816.
- ↑ Arlt W, Allolio B (2003). "Adrenal insufficiency". Lancet. 361 (9372): 1881–93. doi:10.1016/S0140-6736(03)13492-7. PMID 12788587.
- ↑ Uribarri J, Oh MS, Carroll HJ (1990). "Hyperkalemia in diabetes mellitus". J Diabet Complications. 4 (1): 3–7. PMID 2141843.
- ↑ Bojestig M, Nystrom FH, Arnqvist HJ, Ludvigsson J, Karlberg BE (2000). "The renin-angiotensin-aldosterone system is suppressed in adults with Type 1 diabetes". J Renin Angiotensin Aldosterone Syst. 1 (4): 353–6. doi:10.3317/jraas.2000.065. PMID 11967822.
- ↑ Michels AW, Eisenbarth GS (2010). "Immunologic endocrine disorders". J. Allergy Clin. Immunol. 125 (2 Suppl 2): S226–37. doi:10.1016/j.jaci.2009.09.053. PMC 2835296. PMID 20176260.
- ↑ Ben Salem C, Badreddine A, Fathallah N, Slim R, Hmouda H (2014). "Drug-induced hyperkalemia". Drug Saf. 37 (9): 677–92. doi:10.1007/s40264-014-0196-1. PMID 25047526.
- ↑ Kuijvenhoven MA, Haak EA, Gombert-Handoko KB, Crul M (2013). "Evaluation of the concurrent use of potassium-influencing drugs as risk factors for the development of hyperkalemia". Int J Clin Pharm. 35 (6): 1099–104. doi:10.1007/s11096-013-9830-8. PMID 23974985.
- ↑ Indermitte J, Burkolter S, Drewe J, Krähenbühl S, Hersberger KE (2007). "Risk factors associated with a high velocity of the development of hyperkalaemia in hospitalised patients". Drug Saf. 30 (1): 71–80. PMID 17194172.
- ↑ 11.0 11.1 Sousa, André Gustavo P; Cabral, João Victor de Sousa; El-Feghaly, William Batah; Sousa, Luísa Silva de; Nunes, Adriana Bezerra (2016). "Hyporeninemic hypoaldosteronism and diabetes mellitus: Pathophysiology assumptions, clinical aspects and implications for management". World Journal of Diabetes. 7 (5): 101. doi:10.4239/wjd.v7.i5.101. ISSN 1948-9358.
- ↑ Ahmed A (2002). "Use of angiotensin-converting enzyme inhibitors in patients with heart failure and renal insufficiency: how concerned should we be by the rise in serum creatinine?". J Am Geriatr Soc. 50 (7): 1297–300. PMID 12133029.
- ↑ Mangrum AJ, Bakris GL (2004). "Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in chronic renal disease: safety issues". Semin. Nephrol. 24 (2): 168–75. PMID 15017529.