Hypoaldosteronism physical examination: Difference between revisions
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===Appearance of the Patient=== | ===Appearance of the Patient=== | ||
*Patients with hypoaldosteronism usually appear fatigued. | *[[Patients]] with hypoaldosteronism usually appear [[Fatigue|fatigued]]. | ||
===Vital Signs=== | ===Vital Signs=== | ||
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===Skin=== | ===Skin=== | ||
If hypoaldosteronism is from | If hypoaldosteronism is from [[Addison's disease]], changes 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. | * [[Skin pigmentation|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]]. | ||
===Heart=== | ===Heart=== | ||
Hyperkalemia can lead to: | [[Hyperkalemia]] can lead to: | ||
* Irregular heart | * [[Irregular heart rhythms]] | ||
* Bradycardia | * [[Bradycardia]] | ||
* Heart block | * [[Heart block]] | ||
===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 may present with confusion when serum sodium level is <115 mmol/L | *[[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 [[Antidiuretic hormone|ADH]] from [[cortisol]], this leads to increased free water [[absorption]] and [[hyponatremia]]. Patients with [[hyponatremia]] may present with [[confusion]] when serum [[sodium]] level is <115 mmol/L | ||
*Hyporeflexia/areflexia | *[[Hyporeflexia]]/[[areflexia]] | ||
===Extremities=== | ===Extremities=== | ||
*Muscle weakness | *[[Muscle weakness]] | ||
*Muscle tenderness | *Muscle [[tenderness]] | ||
*[[Fasciculations]] | *[[Fasciculations]] | ||
*Depressed deep tendon reflexes | *Depressed [[Deep tendon reflex|deep tendon reflexes]] | ||
==References== | ==References== | ||
Revision as of 15:40, 31 August 2017
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Hypoaldosteronism Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Hypoaldosteronism physical examination On the Web |
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American Roentgen Ray Society Images of Hypoaldosteronism physical examination |
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Risk calculators and risk factors for Hypoaldosteronism physical examination |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Akshun Kalia M.B.B.S.[2]
Overview
Patients with hypoaldosteronism usually appear fatigued. Physical examination of patients with hypoaldosteronism is usually unremarkable, unless there is severe hyperkalemia. Increased level of serum potassium level may present with muscle tenderness, hyporeflexia/areflexia and cardiac arrhythmias. The physical exam may also represent findings of underlying condition such as chronic kidney disease or diabetic nephropathy.
Physical Examination
Patients with hypoaldosteronism usually appear fatigued. Physical examination of patients with hypoaldosteronism is usually unremarkable, unless there is severe hyperkalemia. Increased level of serum potassium level may present with muscle tenderness, hyporeflexia/areflexia and cardiac arrhythmias. The physical exam may also represent findings of underlying condition such as chronic kidney disease or diabetic nephropathy
Appearance of the Patient
Vital Signs
Skin
If hypoaldosteronism is from Addison's disease, changes 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.
Heart
Hyperkalemia can lead to:
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 may present with confusion when serum sodium level is <115 mmol/L
- Hyporeflexia/areflexia
Extremities
- Muscle weakness
- Muscle tenderness
- Fasciculations
- Depressed deep tendon reflexes