Hypoaldosteronism physical examination: Difference between revisions
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* Pigmented skin and mucous membranes - darkening ([[hyperpigmentation]]) of the skin, including areas not exposed to the sun; characteristic sites are skin creases (e.g. of the hands), nipples, and the inside of the cheek (buccal mucosa), also old scars may darken. | * Pigmented skin and mucous membranes - darkening ([[hyperpigmentation]]) of the skin, including areas not exposed to the sun; characteristic sites are skin creases (e.g. of the hands), nipples, and the inside of the cheek (buccal mucosa), also old scars may darken. | ||
* Absence of axillary and pubic hair in females as a result of loss of adrenal [[androgens]] | * Absence of axillary and pubic hair in females as a result of loss of adrenal [[androgens]] | ||
===Abdomen=== | ===Abdomen=== | ||
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*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]] | *[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]] | ||
*Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test | *Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test | ||
===Neuromuscular=== | ===Neuromuscular=== | ||
* | *Hyponatremia is unusual in isolated hypoaldosteronism since ADH is under inhibitory control of cortisol. However, in patients of Addison's disease there is decreased level of cortisol and aldosterone. Since there is no inhibition of ADH from cortisol, this leads to increased free water absorption and hyponatremia. Patients with hyponatremia (sodium <115 mmol/L) may present with confusion when serum sodium level is <115 mmol/L | ||
*Hyporeflexia / areflexia | |||
* | |||
===Extremities=== | ===Extremities=== | ||
Revision as of 17:52, 29 August 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
OR
Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
The presence of [finding(s)] on physical examination is diagnostic of [disease name].
OR
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
Physical Examination
Physical examination of patients with hypoaldosteronism is usually unremarkable, unless there is severe hyperkalemia. The physical findings, if present, represents underlying conditions such as chronic kidney disease and diabetic nephropathy. Increased level of serum potassium level may present with muscle weakness and cardiac arrhythmias.
Appearance of the Patient
- Patients with hypoaldosteronism usually appear fatigued.
Vital Signs
Skin
If hypoaldosteronism is from addison's disease, change in skin and hair may be observed such as:
- Pigmented skin and mucous membranes - darkening (hyperpigmentation) of the skin, including areas not exposed to the sun; characteristic sites are skin creases (e.g. of the hands), nipples, and the inside of the cheek (buccal mucosa), also old scars may darken.
- Absence of axillary and pubic hair in females as a result of loss of adrenal androgens
Abdomen
- Abdominal distention
- Abdominal tenderness in the right/left upper/lower abdominal quadrant
- Rebound tenderness (positive Blumberg sign)
- A palpable abdominal mass in the right/left upper/lower abdominal quadrant
- Guarding may be present
- Hepatomegaly / splenomegaly / hepatosplenomegaly
- Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test
Neuromuscular
- Hyponatremia is unusual in isolated hypoaldosteronism since ADH is under inhibitory control of cortisol. However, in patients of Addison's disease there is decreased level of cortisol and aldosterone. Since there is no inhibition of ADH from cortisol, this leads to increased free water absorption and hyponatremia. Patients with hyponatremia (sodium <115 mmol/L) may present with confusion when serum sodium level is <115 mmol/L
- Hyporeflexia / areflexia
Extremities
- Muscle weakness
- Muscle tenderness
- Depressed deep tendon reflexes