Hypoaldosteronism physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

Patients with hypoaldosteronism usually appear fatigued.Physical examination of patients with hypoaldosteronism is usually unremarkable, unless there is severe hyperkalemia. The physical findings may represent underlying condition such as chronic kidney disease or diabetic nephropathy. Increased level of serum potassium level may present with muscle weakness and cardiac arrhythmias. 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

• Low blood pressure
• Orthostatic hypotension
• Bradycardia

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:

• Irregular heart rate
• Bradycardia
• Heart block

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