Hypoaldosteronism laboratory findings: Difference between revisions
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{{Hypoaldosteronism}} | {{Hypoaldosteronism}} | ||
{{CMG}}; {{AE}} | {{CMG}}; {{AE}}{{Akshun}} | ||
==Overview== | ==Overview== | ||
[[Laboratory]] findings consistent with the [[diagnosis]] of hypoaldosteronism include [[hyperkalemia]] and mild non-anion gap [[metabolic acidosis]]. Other [[Laboratory|lab]] findings include [[hyponatremia]], decreased [[aldosterone]] level, and variable amounts of [[plasma renin activity]] (depends upon the underlying condition). | |||
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==Laboratory Findings== | ==Laboratory Findings== | ||
*Laboratory findings consistent with the diagnosis of hypoaldosteronism include: | *[[Laboratory]] findings consistent with the [[diagnosis]] of hypoaldosteronism include:<ref name="pmid7613258">{{cite journal |vauthors=Shiah CJ, Wu KD, Tsai DM, Liao ST, Siauw CP, Lee LS |title=Diagnostic value of plasma aldosterone/potassium ratio in hypoaldosteronism |journal=J. Formos. Med. Assoc. |volume=94 |issue=5 |pages=248–54 |year=1995 |pmid=7613258 |doi= |url=}}</ref><ref name="LehnhardtKemper2010">{{cite journal|last1=Lehnhardt|first1=Anja|last2=Kemper|first2=Markus J.|title=Pathogenesis, diagnosis and management of hyperkalemia|journal=Pediatric Nephrology|volume=26|issue=3|year=2010|pages=377–384|issn=0931-041X|doi=10.1007/s00467-010-1699-3}}</ref> | ||
**Hyperkalemia | **[[Hyperkalemia]] | ||
**Mild anion gap metabolic acidosis | **Mild non-anion gap [[metabolic acidosis]] | ||
*Patients suspects of hypoaldosteronism | *[[Laboratory]] investigations to be performed in hypoaldosteronism includes:<ref name="pmid20493606">{{cite journal |vauthors=Palmer BF |title=A physiologic-based approach to the evaluation of a patient with hyperkalemia |journal=Am. J. Kidney Dis. |volume=56 |issue=2 |pages=387–93 |year=2010 |pmid=20493606 |doi=10.1053/j.ajkd.2010.01.020 |url=}}</ref> | ||
**Serum [[potassium]]: Hypoaldosteronism patients have [[hyperkalemia]] and should be categorised into mild [[hyperkalemia]] (5.5–6.5 mmol/l), moderate [[hyperkalemia]] (6.5–7.5 mmol/l) and severe [[hyperkalemia]] (>7.5 mmol/l). | |||
**Serum [[sodium]]: In general, [[hyponatremia]] is unusual in hypoaldosteronism but if the cause of hypoaldosteronism is [[adrenal insufficiency]], [[hyponatremia]] may be present. [[Hyponatremia]] must be categorized into mild [[hyponatremia]] (130-134 mmol/L), moderate [[hyponatremia]] (125-129 mmol/L) and severe [[hyponatremia]](<125 mmol/L). | |||
**[[Patients]] suspects of hypoaldosteronism should be checked for [[plasma renin activity]] (PRA), serum [[aldosterone]], and serum [[cortisol]]. | |||
**The following table distinguishes among various subtypes of hypoaldosteronism:<ref name="pmid7778574">{{cite journal |vauthors=Oster JR, Singer I, Fishman LM |title=Heparin-induced aldosterone suppression and hyperkalemia |journal=Am. J. Med. |volume=98 |issue=6 |pages=575–86 |year=1995 |pmid=7778574 |doi= |url=}}</ref><ref name="pmid5444558">{{cite journal |vauthors=Mayes D, Furuyama S, Kem DC, Nugent CA |title=A radioimmunoassay for plasma aldosterone |journal=J. Clin. Endocrinol. Metab. |volume=30 |issue=5 |pages=682–5 |year=1970 |pmid=5444558 |doi=10.1210/jcem-30-5-682 |url=}}</ref><ref name="pmid18216310">{{cite journal |vauthors=Choi MJ, Ziyadeh FN |title=The utility of the transtubular potassium gradient in the evaluation of hyperkalemia |journal=J. Am. Soc. Nephrol. |volume=19 |issue=3 |pages=424–6 |year=2008 |pmid=18216310 |doi=10.1681/ASN.2007091017 |url=}}</ref><ref name="pmid25968592">{{cite journal |vauthors=Ruecker B, Lang-Muritano M, Spanaus K, Welzel M, l'Allemand D, Phan-Hug F, Katschnig C, Konrad D, Holterhus PM, Schoenle EJ |title=The Aldosterone/Renin Ratio as a Diagnostic Tool for the Diagnosis of Primary Hypoaldosteronism in Newborns and Infants |journal=Horm Res Paediatr |volume=84 |issue=1 |pages=43–8 |year=2015 |pmid=25968592 |doi=10.1159/000381852 |url=}}</ref> | |||
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{| | |||
! style="background: #4479BA; color: #FFFFFF; text-align: center " - | Disorder | |||
! style="background: #4479BA; color: #FFFFFF; text-align: center " - | Plasma Renin Activity | |||
! style="background: #4479BA; color: #FFFFFF; text-align: center " - | Plasma Aldosterone | |||
! style="background: #4479BA; color: #FFFFFF; text-align: center " - | Plasma Cortisol | |||
|- | |||
| style="background: #DCDCDC; text-align: center "|Hyporeninemic hypoaldosteronism | |||
| style="background: #F5F5F5; text-align: center "|Low | |||
| style="background: #F5F5F5; text-align: center "|Low | |||
| style="background: #F5F5F5; text-align: center "|Normal | |||
|- | |||
| style="background: #DCDCDC; text-align: center "|Hypereninemic hypoaldosteronism | |||
| style="background: #F5F5F5; text-align: center "|Increased | |||
| style="background: #F5F5F5; text-align: center "|Low | |||
| style="background: #F5F5F5; text-align: center "|Normal/↓ | |||
|- | |||
| style="background: #DCDCDC; text-align: center "|Primary adrenal insufficiency | |||
| style="background: #F5F5F5; text-align: center "|High | |||
| style="background: #F5F5F5; text-align: center "|Low | |||
| style="background: #F5F5F5; text-align: center "|Low | |||
|- | |||
| style="background: #DCDCDC; text-align: center "|Pseudohypoaldosteronism type I | |||
| style="background: #F5F5F5; text-align: center "|High | |||
| style="background: #F5F5F5; text-align: center "|High | |||
| style="background: #F5F5F5; text-align: center "|Normal | |||
|- | |||
| style="background: #DCDCDC; text-align: center "|Pseudohypoaldosteronism type II | |||
| style="background: #F5F5F5; text-align: center "|Normal/↓ | |||
| style="background: #F5F5F5; text-align: center "|Normal/↓ | |||
| style="background: #F5F5F5; text-align: center "|Normal | |||
|} | |||
==References== | ==References== | ||
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Latest revision as of 16:40, 18 October 2017
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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
Laboratory findings consistent with the diagnosis of hypoaldosteronism include hyperkalemia and mild non-anion gap metabolic acidosis. Other lab findings include hyponatremia, decreased aldosterone level, and variable amounts of plasma renin activity (depends upon the underlying condition).
Laboratory Findings
- Laboratory findings consistent with the diagnosis of hypoaldosteronism include:[1][2]
- Hyperkalemia
- Mild non-anion gap metabolic acidosis
- Laboratory investigations to be performed in hypoaldosteronism includes:[3]
- Serum potassium: Hypoaldosteronism patients have hyperkalemia and should be categorised into mild hyperkalemia (5.5–6.5 mmol/l), moderate hyperkalemia (6.5–7.5 mmol/l) and severe hyperkalemia (>7.5 mmol/l).
- Serum sodium: In general, hyponatremia is unusual in hypoaldosteronism but if the cause of hypoaldosteronism is adrenal insufficiency, hyponatremia may be present. Hyponatremia must be categorized into mild hyponatremia (130-134 mmol/L), moderate hyponatremia (125-129 mmol/L) and severe hyponatremia(<125 mmol/L).
- Patients suspects of hypoaldosteronism should be checked for plasma renin activity (PRA), serum aldosterone, and serum cortisol.
- The following table distinguishes among various subtypes of hypoaldosteronism:[4][5][6][7]
| Disorder | Plasma Renin Activity | Plasma Aldosterone | Plasma Cortisol |
|---|---|---|---|
| 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
- ↑ Shiah CJ, Wu KD, Tsai DM, Liao ST, Siauw CP, Lee LS (1995). "Diagnostic value of plasma aldosterone/potassium ratio in hypoaldosteronism". J. Formos. Med. Assoc. 94 (5): 248–54. PMID 7613258.
- ↑ Lehnhardt, Anja; Kemper, Markus J. (2010). "Pathogenesis, diagnosis and management of hyperkalemia". Pediatric Nephrology. 26 (3): 377–384. doi:10.1007/s00467-010-1699-3. ISSN 0931-041X.
- ↑ Palmer BF (2010). "A physiologic-based approach to the evaluation of a patient with hyperkalemia". Am. J. Kidney Dis. 56 (2): 387–93. doi:10.1053/j.ajkd.2010.01.020. PMID 20493606.
- ↑ Oster JR, Singer I, Fishman LM (1995). "Heparin-induced aldosterone suppression and hyperkalemia". Am. J. Med. 98 (6): 575–86. PMID 7778574.
- ↑ Mayes D, Furuyama S, Kem DC, Nugent CA (1970). "A radioimmunoassay for plasma aldosterone". J. Clin. Endocrinol. Metab. 30 (5): 682–5. doi:10.1210/jcem-30-5-682. PMID 5444558.
- ↑ Choi MJ, Ziyadeh FN (2008). "The utility of the transtubular potassium gradient in the evaluation of hyperkalemia". J. Am. Soc. Nephrol. 19 (3): 424–6. doi:10.1681/ASN.2007091017. PMID 18216310.
- ↑ Ruecker B, Lang-Muritano M, Spanaus K, Welzel M, l'Allemand D, Phan-Hug F, Katschnig C, Konrad D, Holterhus PM, Schoenle EJ (2015). "The Aldosterone/Renin Ratio as a Diagnostic Tool for the Diagnosis of Primary Hypoaldosteronism in Newborns and Infants". Horm Res Paediatr. 84 (1): 43–8. doi:10.1159/000381852. PMID 25968592.