Secondary hyperaldosteronism differential diagnosis: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
No edit summary
Line 101: Line 101:
|
|
|↓
|↓
|
|}
Pseudohyperaldosteronism causes:
{| class="wikitable"
! rowspan="2" |Pseudohyperaldosteronism causes
! rowspan="2" |Disease
! rowspan="2" |Cause
! colspan="3" |Labratory
!
|-
!Elevated mineralocorticoid
!Renin
!Aldosterone
!Treatment
|-
| rowspan="9" |Endogenous causes
|Deficiency of 17a-hydroxylase
|
| rowspan="2" |Deoxycorticosterone (DOC)
| rowspan="2" |↓
| rowspan="2" |↓
| rowspan="2" |
|-
|11b-hydroxylase
|
|-
|Apparent mineralocorticoid excess syndrome (AME)
|Genetic or acquired defect of 11-HSD
|
|
|
|Amiloride or triamterene
|-
|Liddle’s syndrome
|Mutation of the epithelial sodium channels (ENaC) gene in the distal renal tubules
|
|
|
|
|-
|Cushing’s syndrome
|
|
|
|
|
|-
|Insensitivity to glucocorticoids (Chrousos syndrome)
|
|
|
|
|
|-
|Aldosterone-secreting adrenocortical carcinoma
|
|
|
|
|
|-
|Geller’s syndrome
|
|
|
|
|
|-
|Gordon’s syndrome
|
|
|
|
|
|-
| rowspan="7" |Exogenous causes
|Corticosteroids with mineralocorticoid activity
|
|
|
|
|
|-
|Hypersodic diets
|
|
|
|
|
|-
|Water intossications
|
|
|
|
|
|-
|Licorice
|
|
|
|
|
|-
|grapefruit
|
|
|
|
|
|-
|Contraceptives
|
|
|
|
|
|-
|Some progestins
|
|
|
|
|
|-
| rowspan="7" |Particular causes of hypertension
|Sclerosis of juxtaglomerular apparatus (diabetic microangiopathy and/or of the elderly)
|
|
|
|
|
|-
|FANS
|
|
|
|
|
|-
|B-Adrenergic agonists
|
|
|
|
|
|-
|Aging
|
|
|
|
|
|-
|Low-renin essential hypertension
|
|
|
|
|
|-
|Autonomic dysfunction
|
|
|
|
|
|-
|Partial/total nephrectomy or removal of renal tissue
|
|
|
|
|
|
|}
|}

Revision as of 16:39, 14 September 2017

Secondary hyperaldosteronism Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Secondary Hyperaldosteronism from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

CT scan Findings

MRI Findings

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Case Studies

Case #1

Secondary hyperaldosteronism differential diagnosis On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Secondary hyperaldosteronism differential diagnosis

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Secondary hyperaldosteronism differential diagnosis

CDC on Secondary hyperaldosteronism differential diagnosis

Secondary hyperaldosteronism differential diagnosis in the news

Blogs on Secondary hyperaldosteronism differential diagnosis

Directions to Hospitals Treating Conn syndrome

Risk calculators and risk factors for Secondary hyperaldosteronism differential diagnosis

Hypertension and hypokalemia

Cause Laboratory
Renin activity Aldosterone levels urinary free cortisone
Renin-producing tumors ↑ ↑ ↓
Apparent mineralocorticoid excess ↓ ↓ ↓↓
Licorice ingestion ↓ ↓ Moderate ↑
Ectopic ACTH production ↓ ↑ Markedly ↑↑
Primary hyperaldosteronism ↓ ↑ ↓
Familial hyperaldosteronism ↓ ↑ ↓
Cushing syndrome ↓ ↑ Markedly ↑↑
Renal artery stenosis ↑ ↑ ↓
Liddle's syndrome ↓ ↓ ↓
Diuretic use Nl ↓
17 alpha hydroxylase deficiency ↓ ↓ ↓
11 beta hydroxylase deficiency ↓ ↓ ↓
Coarctation of aorta ↓

Pseudohyperaldosteronism causes:

Pseudohyperaldosteronism causes Disease Cause Labratory
Elevated mineralocorticoid Renin Aldosterone Treatment
Endogenous causes Deficiency of 17a-hydroxylase Deoxycorticosterone (DOC) ↓ ↓
11b-hydroxylase
Apparent mineralocorticoid excess syndrome (AME) Genetic or acquired defect of 11-HSD Amiloride or triamterene
Liddle’s syndrome Mutation of the epithelial sodium channels (ENaC) gene in the distal renal tubules
Cushing’s syndrome
Insensitivity to glucocorticoids (Chrousos syndrome)
Aldosterone-secreting adrenocortical carcinoma
Geller’s syndrome
Gordon’s syndrome
Exogenous causes Corticosteroids with mineralocorticoid activity
Hypersodic diets
Water intossications
Licorice
grapefruit
Contraceptives
Some progestins
Particular causes of hypertension Sclerosis of juxtaglomerular apparatus (diabetic microangiopathy and/or of the elderly)
FANS
B-Adrenergic agonists
Aging
Low-renin essential hypertension
Autonomic dysfunction
Partial/total nephrectomy or removal of renal tissue

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

 
 
 
 
 
 
 
 
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)


References

  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.
  2. ↑ Nielsen ML, Pareek M, Andersen I (2012). "[Liquorice-induced hypertension and hypokalaemia]". Ugeskr. Laeg. (in Danish). 174 (15): 1024–5. PMID 22487411.
  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.
  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.
  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.
  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.
  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.
  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.
  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.
  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.
  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.
  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.
  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.
  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.
  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.
Retrieved from "https://www.wikidoc.org/index.php?title=Secondary_hyperaldosteronism_differential_diagnosis&oldid=1352465"