Hypoaldosteronism natural history, complications and prognosis

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

Overview

If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].

Common complications of hypoaldosteronism include hyperkalemia, metabolic acidosis, hypotension, hypovolemia and hyponatremia.

Prognosis is generally egood/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.

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 rhythms. 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. Depending upon the presence of underlying conditions such as kidney disease or heart condition patient may be hypervolemic. Otherwise, aldosterone deficiency leads to decreased sodium and water absorption which predisposes to hypovolemia.

Complications

• Common complications of hypoaldosteronism include:
  • Hyperkalemia
  • Hypotension
  • Hypovolemia
  • Metabolic acidosis
  • Hyponatremia

Prognosis

• Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.
• Depending on the extent of the [tumor/disease progression/etc.] at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as poor/good/excellent.
• The presence of hyperkalemia is associated with cardiac arrhythmias which can be fatal.
• [Subtype of disease/malignancy] is associated with the most favorable prognosis.