Primary hyperaldosteronism differential diagnosis: Difference between revisions

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Revision as of 19:09, 10 October 2017

Overview

Primary hyperaldosteronism must be differentiated from other diseases that cause hypertension and hypokalemia such as renal artery stenosis, cushing's syndrome, congenital adrenal hyperplasia, Liddle's syndrome, diuretic use, licorice ingestion and renin-secreting tumors.

Differentiating Primary Hyperaldosteronism from other Diseases

Primary hyperaldosteronism (PA) should be differentiated from other diseases causing hypertension and hypokalemia for example:^[1]^[1]^[2]^[3]^[4]^[5]^[6]^[7]^[8]^[9]^[10]^[11]^[12]^[13]^[14]^[15]

Renal artery stenosis
Cushing's syndrome
Congenital adrenal hyperplasia (CAH)
- 17 alpha hydroxylase deficiency
- 11 beta hydroxylase deficiency
Liddle's syndrome
Diuretic use
Licorice ingestion
Renin-secreting tumors

Hypertension and Hypokalemia

Plasma renin activity

Normal or High (Plasma Renin/Aldosterone ratio <10

Suppressed (Plasma Renin/Aldosterone ratio >20

*Renin-secreting tumors
*Diuretic use
*Renovascular hypertension
*Coarctation of aorta
*Malignant phase hypertension

Urinary aldosterone

Elevated

Normal

Low

Conn's syndrome (Primary aldosteronism)

Profound K+ depletion

• 17 alpha hydroxylase deficiency
• 11 beta hydroxylase deficiency
• Liddle's syndrome
• Licorice ingestion
• Deoxycortisone producing tumor

Add Mineralocrticoid antagonist for 8 weeks

BP response

No BP response

• Deoxycorticosterone excess( Tumor, 17 alpha hydroxylase and 11 beta hydroxylase deficiency)
• Licorice ingestion
•Glucocorticoid resistance

Liddle's syndrome)


Differential Diagnoses	Clinical features											History Findings	Laboratory Findings
Differential Diagnoses		Headache	Nausea	Vomiting	Palpitations	Shortness of breath	Diminished pulses	Fatigue	Constipation	Visual Abnormalities		History Findings	Laboratory Findings
Alzheimer's disease	+++ (Slow cognitive and functional decline with early loss of awareness)	+++	Not helpful	+++	++	-	++	+++	++	++	++	Focal neurological signs absent during early stage (may develop later) Mild extrapyramidal signs	Has the following clinical stages: Pre-clinical Mild cognitive impairment Advanced dementia (full blown dementia)	Neurofibrillary tangles Senile (neuritic) plaques
Lewy body dementia	++	-	Helpful	+++	+	+	+++	+	+++	+++	+++	Focal neurological signs present in majority Strongly associated with extrapyramidal signs Autonomic changes	Early visual hallucinations Muscle rigidity Sleep disturbance	α-synuclein deposits present in neurons
Frontotemporal lobar degeneration	+/-	-	Helpful	+++	+	-	+++	+++	++	+++	-	Focal neurological signs present (motor neuron disease) Extrapyramidal signs present (familial frontotemporal lobar degeneration) Onset in young age Strong familial association Focal atrophy of frontal and temporal lobes Knife-edge atrophy noted on MRI Personality and behavioral changes Language impairment	Two major variants: Progressive nonfluent aphasia Semantic variant Progressive supranuclear palsy	Pick bodies Corticobasal degeneration Ubiquitinated inclusions
Vascular dementia	+ (Dysexecutive syndrome)	-	Helpful	+	+	+	++	-	++	+++	+	Focal neurological signs present typically Mild extrapyramidal signs Depression Mild motor signs in subcortical vascular dementia Slowed processing speed Presentation might be similar to Alzheimer's disease	Stepwise progression and focal neurologic signs (also known as multi-infarct dementia or poststroke dementia)	Multifocal and/or diffuse lesions (lacunes and microinfarcts) The following brain areas may be involved: Subcortical area Thalamus Frontobasallimbic system White matter lesions Hippocampal sclerosis Diffuse post-ischemic lesions

References

↑ ^1.0 ^1.1 Wada N, Jin S, Hui SP, Yanagisawa K, Kurosawa T, Chiba H (2014). "[Differential diagnosis of primary aldosteronism by measurement of hybrid steroids using mass spectrometry]". Rinsho Byori (in Japanese). 62 (3): 276–82. PMID 24800505.
↑ Nielsen ML, Pareek M, Andersen I (2012). "[Liquorice-induced hypertension and hypokalaemia]". Ugeskr. Laeg. (in Danish). 174 (15): 1024–5. PMID 22487411.
↑ Chow KM, Ma RC, Szeto CC, Li PK (2012). "Polycystic kidney disease presenting with hypertension and hypokalemia". Am. J. Kidney Dis. 59 (2): 270–2. doi:10.1053/j.ajkd.2011.08.020. PMID 21962616.
↑ Sarafidis PA, Georgianos PI, Germanidis G, Giavroglou C, Nikolaidis P, Lasaridis AN, Madias NE (2012). "Hypertension and symptomatic hypokalemia in a patient with simultaneous unilateral stenoses of intrarenal arteries and mesangioproliferative glomerulonephritis". Am. J. Kidney Dis. 59 (3): 434–8. doi:10.1053/j.ajkd.2011.11.001. PMID 22154539.
↑ Khosla N, Hogan D (2006). "Mineralocorticoid hypertension and hypokalemia". Semin. Nephrol. 26 (6): 434–40. doi:10.1016/j.semnephrol.2006.10.004. PMID 17275580.
↑ Weiner ID (2013). "Endocrine and hypertensive disorders of potassium regulation: primary aldosteronism". Semin. Nephrol. 33 (3): 265–76. doi:10.1016/j.semnephrol.2013.04.007. PMC 3748390. PMID 23953804.
↑ Martell-Claros N, Abad-Cardiel M, Alvarez-Alvarez B, García-Donaire JA, Pérez CF (2015). "Primary aldosteronism and its various clinical scenarios". J. Hypertens. 33 (6): 1226–32. doi:10.1097/HJH.0000000000000546. PMID 25715092.
↑ Franse LV, Pahor M, Di Bari M, Somes GW, Cushman WC, Applegate WB (2000). "Hypokalemia associated with diuretic use and cardiovascular events in the Systolic Hypertension in the Elderly Program". Hypertension. 35 (5): 1025–30. PMID 10818057.
↑ Rossi E, Farnetti E, Nicoli D, Sazzini M, Perazzoli F, Regolisti G, Grasselli C, Santi R, Negro A, Mazzeo V, Mantero F, Luiselli D, Casali B (2011). "A clinical phenotype mimicking essential hypertension in a newly discovered family with Liddle's syndrome". Am. J. Hypertens. 24 (8): 930–5. doi:10.1038/ajh.2011.76. PMID 21525970.
↑ 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.
↑ Ardhanari S, Kannuswamy R, Chaudhary K, Lockette W, Whaley-Connell A (2015). "Mineralocorticoid and apparent mineralocorticoid syndromes of secondary hypertension". Adv Chronic Kidney Dis. 22 (3): 185–95. doi:10.1053/j.ackd.2015.03.002. PMID 25908467.
↑ Iglesias P, Tajada P, Martínez I, Díez JJ (2009). "[Salt-wasting congenital adrenal hyperplasia associated to hyperreninemic hyperaldosteronism]". Med Clin (Barc) (in Spanish; Castilian). 132 (2): 80–1. doi:10.1016/j.medcli.2008.09.002. PMID 19174076.
↑ Kikuta Y, Sanjo K, Nakajima K, Ashizawa I, Ojima M (1988). "Primary aldosteronism in childhood due to primary adrenal hyperplasia". Tohoku J. Exp. Med. 155 (1): 57–70. PMID 3413779.
↑ Hassan-Smith Z, Stewart PM (2011). "Inherited forms of mineralocorticoid hypertension". Curr Opin Endocrinol Diabetes Obes. 18 (3): 177–85. doi:10.1097/MED.0b013e3283469444. PMID 21494136.
↑ Bartter FC, Henkin RI, Bryan GT (1968). "Aldosterone hypersecretion in "non-salt-losing" congenital adrenal hyperplasia". J. Clin. Invest. 47 (8): 1742–52. doi:10.1172/JCI105864. PMC 297334. PMID 4299011.

Template:WH Template:WS

[pmid24800505-1] 1.0 ^1.1 Wada N, Jin S, Hui SP, Yanagisawa K, Kurosawa T, Chiba H (2014). "[Differential diagnosis of primary aldosteronism by measurement of hybrid steroids using mass spectrometry]". Rinsho Byori (in Japanese). 62 (3): 276–82. PMID 24800505.

[pmid22487411-2] Nielsen ML, Pareek M, Andersen I (2012). "[Liquorice-induced hypertension and hypokalaemia]". Ugeskr. Laeg. (in Danish). 174 (15): 1024–5. PMID 22487411.

[pmid21962616-3] Chow KM, Ma RC, Szeto CC, Li PK (2012). "Polycystic kidney disease presenting with hypertension and hypokalemia". Am. J. Kidney Dis. 59 (2): 270–2. doi:10.1053/j.ajkd.2011.08.020. PMID 21962616.

[pmid22154539-4] Sarafidis PA, Georgianos PI, Germanidis G, Giavroglou C, Nikolaidis P, Lasaridis AN, Madias NE (2012). "Hypertension and symptomatic hypokalemia in a patient with simultaneous unilateral stenoses of intrarenal arteries and mesangioproliferative glomerulonephritis". Am. J. Kidney Dis. 59 (3): 434–8. doi:10.1053/j.ajkd.2011.11.001. PMID 22154539.

[pmid17275580-5] Khosla N, Hogan D (2006). "Mineralocorticoid hypertension and hypokalemia". Semin. Nephrol. 26 (6): 434–40. doi:10.1016/j.semnephrol.2006.10.004. PMID 17275580.

[pmid23953804-6] Weiner ID (2013). "Endocrine and hypertensive disorders of potassium regulation: primary aldosteronism". Semin. Nephrol. 33 (3): 265–76. doi:10.1016/j.semnephrol.2013.04.007. PMC 3748390. PMID 23953804.

[pmid25715092-7] Martell-Claros N, Abad-Cardiel M, Alvarez-Alvarez B, García-Donaire JA, Pérez CF (2015). "Primary aldosteronism and its various clinical scenarios". J. Hypertens. 33 (6): 1226–32. doi:10.1097/HJH.0000000000000546. PMID 25715092.

[pmid10818057-8] Franse LV, Pahor M, Di Bari M, Somes GW, Cushman WC, Applegate WB (2000). "Hypokalemia associated with diuretic use and cardiovascular events in the Systolic Hypertension in the Elderly Program". Hypertension. 35 (5): 1025–30. PMID 10818057.

[pmid21525970-9] Rossi E, Farnetti E, Nicoli D, Sazzini M, Perazzoli F, Regolisti G, Grasselli C, Santi R, Negro A, Mazzeo V, Mantero F, Luiselli D, Casali B (2011). "A clinical phenotype mimicking essential hypertension in a newly discovered family with Liddle's syndrome". Am. J. Hypertens. 24 (8): 930–5. doi:10.1038/ajh.2011.76. PMID 21525970.

[pmid25968592-10] 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.

[pmid25908467-11] Ardhanari S, Kannuswamy R, Chaudhary K, Lockette W, Whaley-Connell A (2015). "Mineralocorticoid and apparent mineralocorticoid syndromes of secondary hypertension". Adv Chronic Kidney Dis. 22 (3): 185–95. doi:10.1053/j.ackd.2015.03.002. PMID 25908467.

[pmid19174076-12] Iglesias P, Tajada P, Martínez I, Díez JJ (2009). "[Salt-wasting congenital adrenal hyperplasia associated to hyperreninemic hyperaldosteronism]". Med Clin (Barc) (in Spanish; Castilian). 132 (2): 80–1. doi:10.1016/j.medcli.2008.09.002. PMID 19174076.

[pmid3413779-13] Kikuta Y, Sanjo K, Nakajima K, Ashizawa I, Ojima M (1988). "Primary aldosteronism in childhood due to primary adrenal hyperplasia". Tohoku J. Exp. Med. 155 (1): 57–70. PMID 3413779.

[pmid21494136-14] Hassan-Smith Z, Stewart PM (2011). "Inherited forms of mineralocorticoid hypertension". Curr Opin Endocrinol Diabetes Obes. 18 (3): 177–85. doi:10.1097/MED.0b013e3283469444. PMID 21494136.

[pmid4299011-15] Bartter FC, Henkin RI, Bryan GT (1968). "Aldosterone hypersecretion in "non-salt-losing" congenital adrenal hyperplasia". J. Clin. Invest. 47 (8): 1742–52. doi:10.1172/JCI105864. PMC 297334. PMID 4299011.

[1]

[2]

[3]

[4]

[5]

[6]

[7]

[8]

[9]

[10]

[11]

[12]

[13]

[14]

[15]

@@ Line 5: / Line 5: @@
 Primary hyperaldosteronism must be differentiated from other diseases that cause [[hypertension]] and [[hypokalemia]] such as [[renal artery stenosis]], [[cushing's syndrome]], [[congenital adrenal hyperplasia]], [[Liddle's syndrome]], [[diuretic]] use, [[licorice]] ingestion and [[renin-secreting tumors]].
-==Differentiating Primary hyperaldosteronism From Other Diseases==
+==Differentiating Primary Hyperaldosteronism from other Diseases==
 Primary hyperaldosteronism (PA) should be differentiated from other diseases causing '''[[hypertension]]''' and '''[[hypokalemia]]''' for example:<ref name="pmid24800505">{{cite journal |vauthors=Wada N, Jin S, Hui SP, Yanagisawa K, Kurosawa T, Chiba H |title=[Differential diagnosis of primary aldosteronism by measurement of hybrid steroids using mass spectrometry] |language=Japanese |journal=Rinsho Byori |volume=62 |issue=3 |pages=276–82 |year=2014 |pmid=24800505 |doi= |url=}}</ref><ref name="pmid24800505">{{cite journal |vauthors=Wada N, Jin S, Hui SP, Yanagisawa K, Kurosawa T, Chiba H |title=[Differential diagnosis of primary aldosteronism by measurement of hybrid steroids using mass spectrometry] |language=Japanese |journal=Rinsho Byori |volume=62 |issue=3 |pages=276–82 |year=2014 |pmid=24800505 |doi= |url=}}</ref><ref name="pmid22487411">{{cite journal |vauthors=Nielsen ML, Pareek M, Andersen I |title=[Liquorice-induced hypertension and hypokalaemia] |language=Danish |journal=Ugeskr. Laeg. |volume=174 |issue=15 |pages=1024–5 |year=2012 |pmid=22487411 |doi= |url=}}</ref><ref name="pmid21962616">{{cite journal |vauthors=Chow KM, Ma RC, Szeto CC, Li PK |title=Polycystic kidney disease presenting with hypertension and hypokalemia |journal=Am. J. Kidney Dis. |volume=59 |issue=2 |pages=270–2 |year=2012 |pmid=21962616 |doi=10.1053/j.ajkd.2011.08.020 |url=}}</ref><ref name="pmid22154539">{{cite journal |vauthors=Sarafidis PA, Georgianos PI, Germanidis G, Giavroglou C, Nikolaidis P, Lasaridis AN, Madias NE |title=Hypertension and symptomatic hypokalemia in a patient with simultaneous unilateral stenoses of intrarenal arteries and mesangioproliferative glomerulonephritis |journal=Am. J. Kidney Dis. |volume=59 |issue=3 |pages=434–8 |year=2012 |pmid=22154539 |doi=10.1053/j.ajkd.2011.11.001 |url=}}</ref><ref name="pmid17275580">{{cite journal |vauthors=Khosla N, Hogan D |title=Mineralocorticoid hypertension and hypokalemia |journal=Semin. Nephrol. |volume=26 |issue=6 |pages=434–40 |year=2006 |pmid=17275580 |doi=10.1016/j.semnephrol.2006.10.004 |url=}}</ref><ref name="pmid23953804">{{cite journal |vauthors=Weiner ID |title=Endocrine and hypertensive disorders of potassium regulation: primary aldosteronism |journal=Semin. Nephrol. |volume=33 |issue=3 |pages=265–76 |year=2013 |pmid=23953804 |pmc=3748390 |doi=10.1016/j.semnephrol.2013.04.007 |url=}}</ref><ref name="pmid25715092">{{cite journal |vauthors=Martell-Claros N, Abad-Cardiel M, Alvarez-Alvarez B, García-Donaire JA, Pérez CF |title=Primary aldosteronism and its various clinical scenarios |journal=J. Hypertens. |volume=33 |issue=6 |pages=1226–32 |year=2015 |pmid=25715092 |doi=10.1097/HJH.0000000000000546 |url=}}</ref><ref name="pmid10818057">{{cite journal |vauthors=Franse LV, Pahor M, Di Bari M, Somes GW, Cushman WC, Applegate WB |title=Hypokalemia associated with diuretic use and cardiovascular events in the Systolic Hypertension in the Elderly Program |journal=Hypertension |volume=35 |issue=5 |pages=1025–30 |year=2000 |pmid=10818057 |doi= |url=}}</ref><ref name="pmid21525970">{{cite journal |vauthors=Rossi E, Farnetti E, Nicoli D, Sazzini M, Perazzoli F, Regolisti G, Grasselli C, Santi R, Negro A, Mazzeo V, Mantero F, Luiselli D, Casali B |title=A clinical phenotype mimicking essential hypertension in a newly discovered family with Liddle's syndrome |journal=Am. J. Hypertens. |volume=24 |issue=8 |pages=930–5 |year=2011 |pmid=21525970 |doi=10.1038/ajh.2011.76 |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><ref name="pmid25908467">{{cite journal |vauthors=Ardhanari S, Kannuswamy R, Chaudhary K, Lockette W, Whaley-Connell A |title=Mineralocorticoid and apparent mineralocorticoid syndromes of secondary hypertension |journal=Adv Chronic Kidney Dis |volume=22 |issue=3 |pages=185–95 |year=2015 |pmid=25908467 |doi=10.1053/j.ackd.2015.03.002 |url=}}</ref><ref name="pmid19174076">{{cite journal |vauthors=Iglesias P, Tajada P, Martínez I, Díez JJ |title=[Salt-wasting congenital adrenal hyperplasia associated to hyperreninemic hyperaldosteronism] |language=Spanish; Castilian |journal=Med Clin (Barc) |volume=132 |issue=2 |pages=80–1 |year=2009 |pmid=19174076 |doi=10.1016/j.medcli.2008.09.002 |url=}}</ref><ref name="pmid3413779">{{cite journal |vauthors=Kikuta Y, Sanjo K, Nakajima K, Ashizawa I, Ojima M |title=Primary aldosteronism in childhood due to primary adrenal hyperplasia |journal=Tohoku J. Exp. Med. |volume=155 |issue=1 |pages=57–70 |year=1988 |pmid=3413779 |doi= |url=}}</ref><ref name="pmid21494136">{{cite journal |vauthors=Hassan-Smith Z, Stewart PM |title=Inherited forms of mineralocorticoid hypertension |journal=Curr Opin Endocrinol Diabetes Obes |volume=18 |issue=3 |pages=177–85 |year=2011 |pmid=21494136 |doi=10.1097/MED.0b013e3283469444 |url=}}</ref><ref name="pmid4299011">{{cite journal |vauthors=Bartter FC, Henkin RI, Bryan GT |title=Aldosterone hypersecretion in "non-salt-losing" congenital adrenal hyperplasia |journal=J. Clin. Invest. |volume=47 |issue=8 |pages=1742–52 |year=1968 |pmid=4299011 |pmc=297334 |doi=10.1172/JCI105864 |url=}}</ref>
 *[[Renal artery stenosis]]
@@ Line 34: / Line 34: @@
 {{familytree | | | | | |I01| | | | | | | | | | | | | | | | | | | | | | | | | | | |I02|I01=• Deoxycorticosterone excess( Tumor, 17 alpha hydroxylase and 11 beta hydroxylase deficiency)<br>• Licorice ingestion<br>•Glucocorticoid resistance|I02=Liddle's syndrome)|}}
 {{familytree/end}}
+{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px" align="center"
+|+
+! rowspan="2" style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Differential Diagnoses}}
+! colspan="11" align="center" style="background:#4479BA; color: #FFFFFF; width: 400px;" + | Clinical features
+! rowspan="2" style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|History Findings}}
+! rowspan="2" style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Laboratory Findings}}
+|-
+|-
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Headache
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Nausea
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Vomiting
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Palpitations
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Shortness of breath
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Diminished pulses
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Fatigue
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Constipation
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Visual Abnormalities
+|-
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Alzheimer's disease]]
+| style="padding: 5px 5px; background: #F5F5F5;" | +++
+(Slow [[cognitive]] and functional decline with early loss of awareness)
+|<nowiki>+++</nowiki>
+|Not helpful
+|<nowiki>+++</nowiki>
+|<nowiki>++</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>++</nowiki>
+|<nowiki>+++</nowiki>
+|<nowiki>++</nowiki>
+|<nowiki>++</nowiki>
+|<nowiki>++</nowiki>
+|
+* [[Focal neurologic signs|Focal neurological signs]] absent during early stage (may develop later)
+* Mild [[extrapyramidal]] signs
+|Has the following clinical stages:
+* Pre-clinical
+* [[Mild cognitive impairment]]
+* Advanced [[dementia]] (full blown dementia)
+|
+* [[Neurofibrillary tangle|Neurofibrillary tangles]]
+* [[Senile plaques|Senile (neuritic) plaques]]
+|-
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Lewy body dementia]]
+| style="padding: 5px 5px; background: #F5F5F5;" | ++
+|<nowiki>-</nowiki>
+|Helpful
+|<nowiki>+++</nowiki>
+|<nowiki>+</nowiki>
+|<nowiki>+</nowiki>
+|<nowiki>+++</nowiki>
+|<nowiki>+</nowiki>
+|<nowiki>+++</nowiki>
+|<nowiki>+++</nowiki>
+|<nowiki>+++</nowiki>
+|
+* Focal neurological signs present in majority
+* Strongly associated with [[extrapyramidal]] signs
+* [[Autonomic]] changes
+|
+* Early [[visual hallucinations]]
+* [[Muscle rigidity]]
+* [[Sleep disturbance]]
+|
+* [[Alpha-synuclein|α-synuclein]] deposits present in [[Neuron|neurons]]
+|-
+| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Frontotemporal lobar degeneration]]
+| style="padding: 5px 5px; background: #F5F5F5;" | +/-
+|<nowiki>-</nowiki>
+|Helpful
+|<nowiki>+++</nowiki>
+|<nowiki>+</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>+++</nowiki>
+|<nowiki>+++</nowiki>
+|<nowiki>++</nowiki>
+|<nowiki>+++</nowiki>
+|<nowiki>-</nowiki>
+|
+* [[Focal neurologic signs|Focal neurological signs]] present ([[motor neuron disease]])
+* [[Extrapyramidal|Extrapyramidal signs]]  present (familial [[Frontotemporal lobar degenerations|frontotemporal lobar degeneration]])
+* Onset in young age
+* Strong [[familial]] association
+* Focal [[atrophy]] of [[Frontal lobe|frontal]] and [[temporal lobes]]
+* Knife-edge [[atrophy]] noted on [[Magnetic resonance imaging|MRI]]
+* [[Personality changes|Personality]] and behavioral changes
+* Language impairment
+|
+* Two major variants:
+** Progressive nonfluent [[aphasia]]
+** [[Semantic Dementia|Semantic]] variant
+* [[Progressive supranuclear palsy]]
+|
+* [[Pick bodies]]
+* [[Corticobasal degeneration]]
+* [[Ubiquitination|Ubiquitinated]] inclusions
+|-
+| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Vascular dementia]]
+| style="padding: 5px 5px; background: #F5F5F5;" | + (Dysexecutive syndrome)
+|<nowiki>-</nowiki>
+|Helpful
+|<nowiki>+</nowiki>
+|<nowiki>+</nowiki>
+|<nowiki>+</nowiki>
+|<nowiki>++</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>++</nowiki>
+|<nowiki>+++</nowiki>
+|<nowiki>+</nowiki>
+|
+* [[Focal neurologic signs|Focal neurological signs]] present typically
+* Mild [[extrapyramidal]] signs
+* [[Depression]]
+* Mild [[Motor disorders|motor signs]] in subcortical [[vascular dementia]]
+* Slowed processing speed
+* Presentation might be similar to Alzheimer's disease
+|
+* Stepwise progression and focal neurologic signs (also known as [[multi-infarct dementia]] or poststroke [[dementia]])
+|
+* Multifocal and/or diffuse lesions (lacunes and microinfarcts)
+* The following [[brain]] areas may be involved:
+** [[Subcortical|Subcortical area]]
+** [[Thalamus]]
+** Frontobasal[[limbic system]]
+** [[White matter]] lesions
+** [[Hippocampal sclerosis]]
+** Diffuse post-ischemic lesions
+|}
 ==References==

Primary hyperaldosteronism differential diagnosis: Difference between revisions

Revision as of 19:09, 10 October 2017

Overview

Differentiating Primary Hyperaldosteronism from other Diseases

References

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