Hypoaldosteronism natural history, complications and prognosis: Difference between revisions
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==Overview== | ==Overview== | ||
If left untreated, hypoaldosteronism leads to hyperkalemia which can alter the function of cardiac conduction pathways. Depending upon the severity of hypoaldosteronism, hyperkalemia can be a life threatening condition. When serum potassium rises above ≥ 9 mEq/L, hyperkalemia may lead to [[ventricular fibrillation]], [[PEA]] and even [[cardiac arrest]]. Common complications of hypoaldosteronism include hyperkalemia, metabolic acidosis, hypotension, hypovolemia and hyponatremia. Depending on the extent of the hyperkalemia and underlying renal or adrenal condition at the time of diagnosis, the prognosis of hypoaldosteronism may vary. Prognosis of hypoaldosteronism is generally good for patients who receive treatment. | If left untreated, hypoaldosteronism leads to [[hyperkalemia]] which can alter the function of [[Electrical conduction system of the heart|cardiac conduction pathways]]. Depending upon the severity of hypoaldosteronism, [[hyperkalemia]] can be a life threatening condition. When [[serum potassium]] rises above ≥ 9 mEq/L, [[hyperkalemia]] may lead to [[ventricular fibrillation]], [[PEA]] and even [[cardiac arrest]]. Common [[complications]] of hypoaldosteronism include [[hyperkalemia]], [[metabolic acidosis]], [[hypotension]], [[hypovolemia]] and [[hyponatremia]]. Depending on the extent of the [[hyperkalemia]] and underlying [[renal]] or [[Adrenal gland|adrenal]] condition at the time of [[diagnosis]], the [[prognosis]] of [[hypoaldosteronism]] may vary. Prognosis of hypoaldosteronism is generally good for [[patients]] who receive treatment. | ||
==Natural History, Complications, and Prognosis== | ==Natural History, Complications, and Prognosis== | ||
===Natural History=== | ===Natural History=== | ||
*If left untreated, hypoaldosteronism can progress to hyperkalemia and hyponatremia with hypo or hyper volemia. | *If left untreated, hypoaldosteronism can progress to [[hyperkalemia]] and [[hyponatremia]] with [[Hypovolemia|hypo]] or [[Hypervolemia|hyper volemia]]. | ||
*Hyperkalemia is an acute life threatening condition since it can alter the electrical activity of the heart and lead to life threatening | *[[Hyperkalemia]] is an acute life threatening condition since it can alter the [[Electrical conduction system of the heart|electrical activity of the heart]] and lead to life threatening [[arrhythmias]]. | ||
*Patients with severe hyperkalemia (>7.5 mmol/l) may present with [[Bundle branch block|bundle branch blocks]] or [[Fascicular block|fascicular blocks]]. | *Patients with severe [[hyperkalemia]] (>7.5 mmol/l) may present with [[Bundle branch block|bundle branch blocks]] or [[Fascicular block|fascicular blocks]]. | ||
*When serum [[potassium]] level ≥ 9 mEq/L, hyperkalemia may lead to [[ventricular fibrillation]], [[PEA]] and even [[cardiac arrest]]. | *When serum [[potassium]] level ≥ 9 mEq/L, hyperkalemia may lead to [[ventricular fibrillation]], [[PEA]] and even [[cardiac arrest]]. | ||
*Hyponatremia is unusual in isolated hypoaldosteronism since under normal conditions cortisol leads to suppression of ADH. However, patients of adrenal insufficiency have decreased cortisol and aldosterone which may progress to hyponatremia. | *[[Hyponatremia]] is unusual in isolated hypoaldosteronism since under normal conditions [[cortisol]] leads to suppression of [[ADH]]. However, patients of [[adrenal insufficiency]] have decreased [[cortisol]] and [[aldosterone]] which may progress to [[hyponatremia]]. | ||
*Aldosterone deficiency leads to decreased sodium and water absorption which predisposes to hypovolemia. However, patients with underlying conditions such as kidney disease or heart condition | *[[Aldosterone]] deficiency leads to decreased [[sodium]] and [[water]] [[absorption]] which predisposes to [[hypovolemia]]. However, patients with underlying conditions such as [[kidney disease]] or [[heart condition]] may be [[Hypervolemia|hypervolemic]]. | ||
===Complications=== | ===Complications=== | ||
*Common complications of hypoaldosteronism include: | *Common [[complications]] of hypoaldosteronism include: | ||
**Hyperkalemia | **[[Hyperkalemia]] | ||
**Hypotension | **[[Hypotension]] | ||
**Hypovolemia | **[[Hypovolemia]] | ||
**Metabolic acidosis | **[[Metabolic acidosis]] | ||
**Hyponatremia | **[[Hyponatremia]] | ||
===Prognosis=== | ===Prognosis=== | ||
*Depending on the extent of the hyperkalemia and underlying renal or adrenal condition at the time of diagnosis, the prognosis of hypoaldosteronism may vary. | *Depending on the extent of the [[hyperkalemia]] and underlying [[renal]] or [[adrenal]] condition at the time of [[diagnosis]], the [[prognosis]] of hypoaldosteronism may vary. | ||
*Prognosis is generally good for patients of hypoaldosteronism who receive treatment. | *[[Prognosis]] is generally good for patients of hypoaldosteronism who receive treatment. | ||
*Untreated patients risk having hyperkalemia which is associated with cardiac arrhythmias that can be fatal. | *Untreated [[patients]] risk having [[hyperkalemia]] which is associated with [[cardiac arrhythmias]] that can be [[fatal]]. | ||
*Patient having underlying renal insufficiency or diabetic nephropathy generally progresses to end stage stage renal disease. Drugs such as ACEi and ARBs which are the mainstay of treatment with diabetes and renal dysfunction are avoided in hypoaldosteronism since these may lead to hyperkalemia. | *Patient having underlying [[renal insufficiency]] or [[diabetic nephropathy]] generally progresses to [[End stage renal disease|end stage stage renal disease]]. Drugs such as [[ACE inhibitor|ACEi]] and [[ARBs]] which are the mainstay of treatment with [[diabetes]] and [[renal dysfunction]] are avoided in hypoaldosteronism since these may lead to [[hyperkalemia]]. | ||
==References== | ==References== | ||
Revision as of 15:09, 31 August 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
If left untreated, hypoaldosteronism leads to hyperkalemia which can alter the function of cardiac conduction pathways. Depending upon the severity of hypoaldosteronism, hyperkalemia can be a life threatening condition. When serum potassium rises above ≥ 9 mEq/L, hyperkalemia may lead to ventricular fibrillation, PEA and even cardiac arrest. Common complications of hypoaldosteronism include hyperkalemia, metabolic acidosis, hypotension, hypovolemia and hyponatremia. Depending on the extent of the hyperkalemia and underlying renal or adrenal condition at the time of diagnosis, the prognosis of hypoaldosteronism may vary. Prognosis of hypoaldosteronism is generally good for patients who receive treatment.
Natural History, Complications, and Prognosis
Natural History
- If left untreated, hypoaldosteronism can progress to hyperkalemia and hyponatremia with hypo or hyper volemia.
- Hyperkalemia is an acute life threatening condition since it can alter the electrical activity of the heart and lead to life threatening arrhythmias.
- Patients with severe hyperkalemia (>7.5 mmol/l) may present with bundle branch blocks or fascicular blocks.
- When serum potassium level ≥ 9 mEq/L, hyperkalemia may lead to ventricular fibrillation, PEA and even cardiac arrest.
- Hyponatremia is unusual in isolated hypoaldosteronism since under normal conditions cortisol leads to suppression of ADH. However, patients of adrenal insufficiency have decreased cortisol and aldosterone which may progress to hyponatremia.
- Aldosterone deficiency leads to decreased sodium and water absorption which predisposes to hypovolemia. However, patients with underlying conditions such as kidney disease or heart condition may be hypervolemic.
Complications
- Common complications of hypoaldosteronism include:
Prognosis
- Depending on the extent of the hyperkalemia and underlying renal or adrenal condition at the time of diagnosis, the prognosis of hypoaldosteronism may vary.
- Prognosis is generally good for patients of hypoaldosteronism who receive treatment.
- Untreated patients risk having hyperkalemia which is associated with cardiac arrhythmias that can be fatal.
- Patient having underlying renal insufficiency or diabetic nephropathy generally progresses to end stage stage renal disease. Drugs such as ACEi and ARBs which are the mainstay of treatment with diabetes and renal dysfunction are avoided in hypoaldosteronism since these may lead to hyperkalemia.