Hypoaldosteronism laboratory findings: Difference between revisions

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{{Hypoaldosteronism}}
{{Hypoaldosteronism}}


{{CMG}}; {{AE}}  
{{CMG}}; {{AE}}{{Akshun}}


==Overview==
==Overview==
A positive history of hypotension, muscle weakness and fatigue should raise suspicion for hypoaldosteronism.
[[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).
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].
 
OR
 
Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
 
OR
 
[Test] is usually normal among patients with [disease name].
 
OR
 
Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].
 
OR
 
There are no diagnostic laboratory findings associated with [disease name].


==Laboratory Findings==
==Laboratory Findings==
*[[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]]
**Mild non-anion gap [[metabolic acidosis]]


*There are no diagnostic laboratory findings associated with [disease name].
*[[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>
OR
**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).
*An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].
**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).  
*[Test] is usually normal among patients with [disease name].
**[[Patients]] suspects of hypoaldosteronism should be checked for [[plasma renin activity]] (PRA), serum [[aldosterone]], and serum [[cortisol]].  
*Laboratory findings consistent with the diagnosis of hypoaldosteronism include:
**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>
**Hyperkalemia
<br>
**Mild anion gap metabolic acidosis
{|
**[abnormal test 3]
! style="background: #4479BA; color: #FFFFFF; text-align: center " - | Disorder
 
! style="background: #4479BA; color: #FFFFFF; text-align: center " - | Plasma Renin Activity
*Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].
! 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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[[Category:Disease]]
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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


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

  1. ↑ 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.
  2. ↑ 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.
  3. ↑ 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.
  4. ↑ Oster JR, Singer I, Fishman LM (1995). "Heparin-induced aldosterone suppression and hyperkalemia". Am. J. Med. 98 (6): 575–86. PMID 7778574.
  5. ↑ 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.
  6. ↑ 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.
  7. ↑ 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.

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