Differentiating Secondary adrenal insufficiency from other diseases: Difference between revisions
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|Normal | |Normal | ||
| style="background: #F5F5F5; padding: 5px; "[[Cosyntropin]]/ [[ACTH stimulation test|ACTH stimulation tes]]<nowiki/>t | | style="background: #F5F5F5; padding: 5px; "[[Cosyntropin]]/ [[ACTH stimulation test|ACTH stimulation tes]]<nowiki/>t | ||
|style="background: #F5F5F5; padding: 5px; " | | style="background: #F5F5F5; padding: 5px; " | ||
* CT scan/ MRI scan showing pituitary causes | * CT scan/ MRI scan showing pituitary causes | ||
| | | | ||
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* [[Anesthesia]] ([[etomidate]]) | * [[Anesthesia]] ([[etomidate]]) | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | + | | style="background: #F5F5F5; padding: 5px; text-align:center" | + | ||
|style="background: #F5F5F5; padding: 5px; "Normal to Low | | style="background: #F5F5F5; padding: 5px; "Normal to Low | ||
|style="background: #F5F5F5; padding: 5px; "[[Cosyntropin]]/ [[ACTH stimulation test|ACTH stimulation tes]]<nowiki/>t | | style="background: #F5F5F5; padding: 5px; "[[Cosyntropin]]/ [[ACTH stimulation test|ACTH stimulation tes]]<nowiki/>t | ||
|style="background: #F5F5F5; padding: 5px; " | | style="background: #F5F5F5; padding: 5px; " | ||
* [[ECG]] (electrocardiogram) | * [[ECG]] (electrocardiogram) | ||
* [[CBC]] (complete blood count) | * [[CBC]] (complete blood count) | ||
* [[BUN]] (blood urea nitrogen) | * [[BUN]] (blood urea nitrogen) | ||
* [[Creatinine]] | * [[Creatinine]] | ||
|style="background: #F5F5F5; padding: 5px; " | | style="background: #F5F5F5; padding: 5px; " | ||
* I/V 0.9% saline 1-3 liters within 12-24 hours | * I/V 0.9% saline 1-3 liters within 12-24 hours | ||
* I/V [[Dexamethasone]] 4 mg bolus, ''or,'' I/V [[hydrocortisone]] 50 mg bolus | * I/V [[Dexamethasone]] 4 mg bolus, ''or,'' I/V [[hydrocortisone]] 50 mg bolus | ||
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| style="padding: 5px 5px; background: #DCDCDC;" align="center" | | | style="padding: 5px 5px; background: #DCDCDC;" align="center" | | ||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |'''[[Adrenal hemorrhage]]/ Waterhouse Friderichsen syndrome''' | | style="padding: 5px 5px; background: #DCDCDC;" align="center" |'''[[Adrenal hemorrhage]]/ Waterhouse Friderichsen syndrome''' | ||
|style="background: #F5F5F5; padding: 5px; "orthostatic | | style="background: #F5F5F5; padding: 5px; "orthostatic | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | ± | | style="background: #F5F5F5; padding: 5px; text-align:center" | ± | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | + | | style="background: #F5F5F5; padding: 5px; text-align:center" | + | ||
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| style="background: #F5F5F5; padding: 5px; text-align:center" | + | | style="background: #F5F5F5; padding: 5px; text-align:center" | + | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | – | | style="background: #F5F5F5; padding: 5px; text-align:center" | – | ||
|style="background: #F5F5F5; padding: 5px; " | | style="background: #F5F5F5; padding: 5px; " | ||
* [[Fever]] | * [[Fever]] | ||
* [[Tachycardia]] | * [[Tachycardia]] | ||
| Line 134: | Line 134: | ||
* [[Nausea and vomiting|Nausea]]/ [[Nausea and vomiting|vomiting]] | * [[Nausea and vomiting|Nausea]]/ [[Nausea and vomiting|vomiting]] | ||
* [[Diarrhea]] | * [[Diarrhea]] | ||
|style="background: #F5F5F5; padding: 5px; " | | style="background: #F5F5F5; padding: 5px; " | ||
* Infection | * Infection | ||
# Sepsis- [[pneumonia]] | # Sepsis- [[pneumonia]] | ||
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* Tumors- Adrenal adenomas, [[pheochromocytoma]] | * Tumors- Adrenal adenomas, [[pheochromocytoma]] | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | + | | style="background: #F5F5F5; padding: 5px; text-align:center" | + | ||
|style="background: #F5F5F5; padding: 5px; "Normal to low | | style="background: #F5F5F5; padding: 5px; "Normal to low | ||
|style="background: #F5F5F5; padding: 5px; "[[Cosyntropin]]/ [[ACTH stimulation test|ACTH stimulation tes]]<nowiki/>t | | style="background: #F5F5F5; padding: 5px; "[[Cosyntropin]]/ [[ACTH stimulation test|ACTH stimulation tes]]<nowiki/>t | ||
|style="background: #F5F5F5; padding: 5px; " | | style="background: #F5F5F5; padding: 5px; " | ||
* [[CBC]] (Complete blood count) | * [[CBC]] (Complete blood count) | ||
* CT scan | * CT scan | ||
|style="background: #F5F5F5; padding: 5px; " | | style="background: #F5F5F5; padding: 5px; " | ||
* Stabilize the patient | * Stabilize the patient | ||
* Treat the underlying cause | * Treat the underlying cause | ||
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| style="padding: 5px 5px; background: #DCDCDC;" align="center" | | | style="padding: 5px 5px; background: #DCDCDC;" align="center" | | ||
| style="padding: 5px 5px; background: #DCDCDC;" |'''[[Congenital Adrenal Hyperplasia|Congenital adrenal hyperplasia]] (CAH)''' | | style="padding: 5px 5px; background: #DCDCDC;" |'''[[Congenital Adrenal Hyperplasia|Congenital adrenal hyperplasia]] (CAH)''' | ||
|style="background: #F5F5F5; padding: 5px; "Normal to hypertension | | style="background: #F5F5F5; padding: 5px; "Normal to hypertension | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |± | | style="background: #F5F5F5; padding: 5px; text-align:center" |± | ||
(can be indicator of Uncontrolled CAH)<ref name="pmid27072733">{{cite journal |vauthors=Patel FB, Newman SA, Norton SA |title=Addisonian-Like Hyperpigmentation as an Indicator of Uncontrolled Congenital Adrenal Hyperplasia |journal=Skinmed |volume=14 |issue=1 |pages=53–4 |year=2016 |pmid=27072733 |doi= |url=}}</ref> | (can be indicator of Uncontrolled CAH)<ref name="pmid27072733">{{cite journal |vauthors=Patel FB, Newman SA, Norton SA |title=Addisonian-Like Hyperpigmentation as an Indicator of Uncontrolled Congenital Adrenal Hyperplasia |journal=Skinmed |volume=14 |issue=1 |pages=53–4 |year=2016 |pmid=27072733 |doi= |url=}}</ref> | ||
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| style="background: #F5F5F5; padding: 5px; text-align:center" |– | | style="background: #F5F5F5; padding: 5px; text-align:center" |– | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |– | | style="background: #F5F5F5; padding: 5px; text-align:center" |– | ||
|style="background: #F5F5F5; padding: 5px; " | | style="background: #F5F5F5; padding: 5px; " | ||
* Female- [[Ambiguous genitalia]]/ [[virilization]], [[infertility]] | * Female- [[Ambiguous genitalia]]/ [[virilization]], [[infertility]] | ||
* Male- Normal or enlarged [[Phallus (embryology)|phallus]] | * Male- Normal or enlarged [[Phallus (embryology)|phallus]] | ||
* [[Short stature]] | * [[Short stature]] | ||
|style="background: #F5F5F5; padding: 5px; " | | style="background: #F5F5F5; padding: 5px; " | ||
* [[21-hydroxylase deficiency|21-hydroxylase deficiency]] | * [[21-hydroxylase deficiency|21-hydroxylase deficiency]] | ||
* 17α hydroxylase deficiency | * 17α hydroxylase deficiency | ||
* 11 β hydroxylase deficiency | * 11 β hydroxylase deficiency | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |± | | style="background: #F5F5F5; padding: 5px; text-align:center" |± | ||
|style="background: #F5F5F5; padding: 5px; "Low | | style="background: #F5F5F5; padding: 5px; "Low | ||
|style="background: #F5F5F5; padding: 5px; "[[Cosyntropin]]/ [[ACTH stimulation test|ACTH stimulation tes]]<nowiki/>t | | style="background: #F5F5F5; padding: 5px; "[[Cosyntropin]]/ [[ACTH stimulation test|ACTH stimulation tes]]<nowiki/>t | ||
|style="background: #F5F5F5; padding: 5px; " | | style="background: #F5F5F5; padding: 5px; " | ||
* Serum 17-hydroxyprogesterone | * Serum 17-hydroxyprogesterone | ||
* [[Hyperkalemia]] | * [[Hyperkalemia]] | ||
|style="background: #F5F5F5; padding: 5px; " | | style="background: #F5F5F5; padding: 5px; " | ||
* [[Hydrocortisone]] -15 to 25 mg PO daily in 2 to 3 divided doses | * [[Hydrocortisone]] -15 to 25 mg PO daily in 2 to 3 divided doses | ||
* [[Fludrocortisone]] - 0.1 to 0.2 mg PO q daily | * [[Fludrocortisone]] - 0.1 to 0.2 mg PO q daily | ||
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| style="background: #F5F5F5; padding: 5px; text-align:center" |– | | style="background: #F5F5F5; padding: 5px; text-align:center" |– | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |– | | style="background: #F5F5F5; padding: 5px; text-align:center" |– | ||
|style="background: #F5F5F5; padding: 5px; " | | style="background: #F5F5F5; padding: 5px; " | ||
* [[Nausea]]/[[vomiting]] | * [[Nausea]]/[[vomiting]] | ||
* [[Cramps]] | * [[Cramps]] | ||
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* [[Hallucinations]] | * [[Hallucinations]] | ||
* [[Seizures]], [[stupor]] or [[coma]] | * [[Seizures]], [[stupor]] or [[coma]] | ||
|style="background: #F5F5F5; padding: 5px; " | | style="background: #F5F5F5; padding: 5px; " | ||
* Head trauma-[[subarachnoid hemorrhage]] | * Head trauma-[[subarachnoid hemorrhage]] | ||
* Tumors- [[Intracerebral metastases|metastasis]] | * Tumors- [[Intracerebral metastases|metastasis]] | ||
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* Drugs- [[chlorpropamide]], [[cyclophosphamide]], [[carbamazepine]], [[selective serotonin reuptake inhibitors]], [[methylenedioxymethamphetamine]] (MDMA, commonly called [[Ecstasy (drug)|Ecstasy]]) | * Drugs- [[chlorpropamide]], [[cyclophosphamide]], [[carbamazepine]], [[selective serotonin reuptake inhibitors]], [[methylenedioxymethamphetamine]] (MDMA, commonly called [[Ecstasy (drug)|Ecstasy]]) | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | + | | style="background: #F5F5F5; padding: 5px; text-align:center" | + | ||
|style="background: #F5F5F5; padding: 5px; "Normal | | style="background: #F5F5F5; padding: 5px; "Normal | ||
|style="background: #F5F5F5; padding: 5px; "Water deprivation test | | style="background: #F5F5F5; padding: 5px; "Water deprivation test | ||
|style="background: #F5F5F5; padding: 5px; " | | style="background: #F5F5F5; padding: 5px; " | ||
* Decreased [[osmolality]] | * Decreased [[osmolality]] | ||
* Euvolemia | * Euvolemia | ||
* Sodium in urine typically >20 mEq/ | * Sodium in urine typically >20 mEq/ | ||
|style="background: #F5F5F5; padding: 5px; " | | style="background: #F5F5F5; padding: 5px; " | ||
* Mild- Fluid restriction | * Mild- Fluid restriction | ||
* Moderate- [[Loop diuretics]] | * Moderate- [[Loop diuretics]] | ||
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| style="background: #F5F5F5; padding: 5px; text-align:center" | + Flank pain | | style="background: #F5F5F5; padding: 5px; text-align:center" | + Flank pain | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | – | | style="background: #F5F5F5; padding: 5px; text-align:center" | – | ||
|style="background: #F5F5F5; padding: 5px; " | | style="background: #F5F5F5; padding: 5px; " | ||
* [[Fever]] | * [[Fever]] | ||
* [[Dysuria]] | * [[Dysuria]] | ||
* [[Pyuria]] | * [[Pyuria]] | ||
* [[Oliguria]] | * [[Oliguria]] | ||
|style="background: #F5F5F5; padding: 5px; " | | style="background: #F5F5F5; padding: 5px; " | ||
* [[Chronic renal failure]] | * [[Chronic renal failure]] | ||
* [[Bartter syndrome]]<ref name="pmid26178649">{{cite journal |vauthors=Seyberth HW |title=Pathophysiology and clinical presentations of salt-losing tubulopathies |journal=Pediatr. Nephrol. |volume=31 |issue=3 |pages=407–18 |year=2016 |pmid=26178649 |doi=10.1007/s00467-015-3143-1 |url=}}</ref> | * [[Bartter syndrome]]<ref name="pmid26178649">{{cite journal |vauthors=Seyberth HW |title=Pathophysiology and clinical presentations of salt-losing tubulopathies |journal=Pediatr. Nephrol. |volume=31 |issue=3 |pages=407–18 |year=2016 |pmid=26178649 |doi=10.1007/s00467-015-3143-1 |url=}}</ref> | ||
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* Drugs- [[Tacrolimus]]<ref name="pmid27500237">{{cite journal |vauthors=Sayin B |title=Tacrolimus-Induced Salt Losing Nephropathy Resolved After Conversion to Everolimus |journal=Transplant Direct |volume=1 |issue=9 |pages=e37 |year=2015 |pmid=27500237 |pmc=4946484 |doi=10.1097/TXD.0000000000000538 |url=}}</ref> | * Drugs- [[Tacrolimus]]<ref name="pmid27500237">{{cite journal |vauthors=Sayin B |title=Tacrolimus-Induced Salt Losing Nephropathy Resolved After Conversion to Everolimus |journal=Transplant Direct |volume=1 |issue=9 |pages=e37 |year=2015 |pmid=27500237 |pmc=4946484 |doi=10.1097/TXD.0000000000000538 |url=}}</ref> | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | ++<ref name="pmid19888422">{{cite journal |vauthors=Yoshioka K, Nishio M, Sano S, Sakurai K, Yamagami K, Yamashita Y |title=Development of Severe Hyponatremia due to Salt-Losing Nephropathy after Esophagectomy for Esophageal Cancer |journal=Case Rep Med |volume=2009 |issue= |pages=241283 |year=2009 |pmid=19888422 |pmc=2771150 |doi=10.1155/2009/241283 |url=}}</ref> | | style="background: #F5F5F5; padding: 5px; text-align:center" | ++<ref name="pmid19888422">{{cite journal |vauthors=Yoshioka K, Nishio M, Sano S, Sakurai K, Yamagami K, Yamashita Y |title=Development of Severe Hyponatremia due to Salt-Losing Nephropathy after Esophagectomy for Esophageal Cancer |journal=Case Rep Med |volume=2009 |issue= |pages=241283 |year=2009 |pmid=19888422 |pmc=2771150 |doi=10.1155/2009/241283 |url=}}</ref> | ||
|style="background: #F5F5F5; padding: 5px; "High | | style="background: #F5F5F5; padding: 5px; "High | ||
|style="background: #F5F5F5; padding: 5px; "Genetic study | | style="background: #F5F5F5; padding: 5px; "Genetic study | ||
|style="background: #F5F5F5; padding: 5px; "<15:1 [[BUN-to-creatinine ratio|BUN:CR]] | | style="background: #F5F5F5; padding: 5px; "<15:1 [[BUN-to-creatinine ratio|BUN:CR]] | ||
|style="background: #F5F5F5; padding: 5px; " | | style="background: #F5F5F5; padding: 5px; " | ||
* [[Fludrocortisone]] - 0.05 to 0.2 mg PO q daily | * [[Fludrocortisone]] - 0.05 to 0.2 mg PO q daily | ||
|- | |- | ||
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| style="background: #F5F5F5; padding: 5px; text-align:center" | – | | style="background: #F5F5F5; padding: 5px; text-align:center" | – | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | + | | style="background: #F5F5F5; padding: 5px; text-align:center" | + | ||
|style="background: #F5F5F5; padding: 5px; " | | style="background: #F5F5F5; padding: 5px; " | ||
* Distorted body image | * Distorted body image | ||
* [[Hypoglycemia]] | * [[Hypoglycemia]] | ||
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* [[Osteoporosis]] | * [[Osteoporosis]] | ||
* [[Refeeding syndrome]] | * [[Refeeding syndrome]] | ||
|style="background: #F5F5F5; padding: 5px; " | | style="background: #F5F5F5; padding: 5px; " | ||
* Genetic | * Genetic | ||
* Hormonal- Low [[dopamine]] and [[serotonin]] | * Hormonal- Low [[dopamine]] and [[serotonin]] | ||
* Psychological | * Psychological | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |– | | style="background: #F5F5F5; padding: 5px; text-align:center" |– | ||
|style="background: #F5F5F5; padding: 5px; "High | | style="background: #F5F5F5; padding: 5px; "High | ||
|style="background: #F5F5F5; padding: 5px; "Psychiatric condition | | style="background: #F5F5F5; padding: 5px; "Psychiatric condition | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |– | | style="background: #F5F5F5; padding: 5px; text-align:center" |– | ||
|style="background: #F5F5F5; padding: 5px; " | | style="background: #F5F5F5; padding: 5px; " | ||
* Nutritional replacement | * Nutritional replacement | ||
* Psychotherapy- e.g. [[Cognitive behavioral therapy]] | * Psychotherapy- e.g. [[Cognitive behavioral therapy]] | ||
Revision as of 18:39, 3 October 2017
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Adrenal insufficiency Microchapters |
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Case Studies |
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Differentiating Secondary adrenal insufficiency from other diseases On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Amandeep Singh M.D.[2]
Overview
Secondary adrenal insufficiency must be differentiated from primary adrenal insufficiency, acute adrenal insufficiency/adrenal crisis, adrenal hemorrhage,congenital adrenal hyperplasia and salt losing nephropathy.
Adrenal Insufficiency
| Acute/
Chronic |
Disease | Clinical history/findings | Causes | Laboratory findings | Medical therapy | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Hypotension | Skin
pigmentation/ findings |
Fatigue | Anorexia/
weightloss |
Abdominal pain | Muscle
weakness |
Other history
findings |
Hypo
natremia |
Cortisol levels | Gold Standard | Other | ||||
| Differentiating amongst adrenal insufficiencies | ||||||||||||||
| Chronic | Primary adrenal | + | + | + | + | + | + |
|
+ | Low | Cosyntropin/ ACTH stimulation test |
| ||
| Chronic | Secondary adrenal
insufficiency |
± | – | + | + | – | ± |
|
|
– | Normal | style="background: #F5F5F5; padding: 5px; "Cosyntropin/ ACTH stimulation test | style="background: #F5F5F5; padding: 5px; "
|
|
| Acute | Acute adrenal insufficiency/ Acute adrenal crisis | ++ | ± | + | + | + | ± | style="background: #F5F5F5; padding: 5px; "
|
style="background: #F5F5F5; padding: 5px; " | + | style="background: #F5F5F5; padding: 5px; "Normal to Low | style="background: #F5F5F5; padding: 5px; "Cosyntropin/ ACTH stimulation test | style="background: #F5F5F5; padding: 5px; "
|
style="background: #F5F5F5; padding: 5px; "
|
| Differentiating Adrenal Insufficiency from other diseases | ||||||||||||||
| Adrenal hemorrhage/ Waterhouse Friderichsen syndrome | style="background: #F5F5F5; padding: 5px; "orthostatic | ± | + | ± | + | – | style="background: #F5F5F5; padding: 5px; " | style="background: #F5F5F5; padding: 5px; "
|
+ | style="background: #F5F5F5; padding: 5px; "Normal to low | style="background: #F5F5F5; padding: 5px; "Cosyntropin/ ACTH stimulation test | style="background: #F5F5F5; padding: 5px; "
|
style="background: #F5F5F5; padding: 5px; "
| |
| Congenital adrenal hyperplasia (CAH) | style="background: #F5F5F5; padding: 5px; "Normal to hypertension | ±
(can be indicator of Uncontrolled CAH)[6] |
– | – | – | – | style="background: #F5F5F5; padding: 5px; "
|
style="background: #F5F5F5; padding: 5px; "
|
± | style="background: #F5F5F5; padding: 5px; "Low | style="background: #F5F5F5; padding: 5px; "Cosyntropin/ ACTH stimulation test | style="background: #F5F5F5; padding: 5px; "
|
style="background: #F5F5F5; padding: 5px; "
| |
| Syndrome of inappropriate antidiuretic hormone (SIADH) | – | – | – | – | – | – | style="background: #F5F5F5; padding: 5px; " | style="background: #F5F5F5; padding: 5px; "
|
+ | style="background: #F5F5F5; padding: 5px; "Normal | style="background: #F5F5F5; padding: 5px; "Water deprivation test | style="background: #F5F5F5; padding: 5px; "
|
style="background: #F5F5F5; padding: 5px; "
| |
| Salt-depletion nephritis/ Salt losing nephropathy | + | – | – | – | + Flank pain | – | style="background: #F5F5F5; padding: 5px; " | style="background: #F5F5F5; padding: 5px; " | ++[9] | style="background: #F5F5F5; padding: 5px; "High | style="background: #F5F5F5; padding: 5px; "Genetic study | style="background: #F5F5F5; padding: 5px; "<15:1 BUN:CR | style="background: #F5F5F5; padding: 5px; "
| |
| Anorexia nervosa | + | – | + | + | – | + | style="background: #F5F5F5; padding: 5px; "
|
style="background: #F5F5F5; padding: 5px; " | – | style="background: #F5F5F5; padding: 5px; "High | style="background: #F5F5F5; padding: 5px; "Psychiatric condition | – | style="background: #F5F5F5; padding: 5px; "
| |
References
- ↑ Patnaik MM, Deshpande AK (2008). "Diagnosis--Addison's disease secondary to tuberculosis of the adrenal glands". Clin Med Res. 6 (1): 29. doi:10.3121/cmr.2007.754a. PMC 2442022. PMID 18591375.
- ↑ Bhattacharjee R, Sharma A, Rays A, Thakur I, Sarkar D, Mandal B, Mookerjee SK, Chatterjee SK, Chowdhury PR (2013). "Addison's disease presenting with muscle spasm". J Assoc Physicians India. 61 (9): 675–6. PMID 24772716.
- ↑ Ray A, Sanyal D (2016). "A rare case of Addison's disease due to bilateral adrenal histoplasmosis presenting with hypoglycaemia". J Assoc Physicians India. 64 (1): 45–46. PMID 27727656.
- ↑ Choudhary N, Aggarwal I, Dutta D, Ghosh AG, Chatterjee G, Chowdhury S (2013). "Acquired perforating dermatosis and Addison's disease due to disseminated histoplasmosis: Presentation and clinical outcomes". Dermatoendocrinol. 5 (2): 305–8. doi:10.4161/derm.22677. PMC 3772918. PMID 24194970.
- ↑ Schimke KE, Greminger P, Brändle M (2009). "Secondary adrenal insufficiency due to opiate therapy - another differential diagnosis worth consideration". Exp. Clin. Endocrinol. Diabetes. 117 (10): 649–51. doi:10.1055/s-0029-1202851. PMID 19373753.
- ↑ Patel FB, Newman SA, Norton SA (2016). "Addisonian-Like Hyperpigmentation as an Indicator of Uncontrolled Congenital Adrenal Hyperplasia". Skinmed. 14 (1): 53–4. PMID 27072733.
- ↑ Seyberth HW (2016). "Pathophysiology and clinical presentations of salt-losing tubulopathies". Pediatr. Nephrol. 31 (3): 407–18. doi:10.1007/s00467-015-3143-1. PMID 26178649.
- ↑ Sayin B (2015). "Tacrolimus-Induced Salt Losing Nephropathy Resolved After Conversion to Everolimus". Transplant Direct. 1 (9): e37. doi:10.1097/TXD.0000000000000538. PMC 4946484. PMID 27500237.
- ↑ Yoshioka K, Nishio M, Sano S, Sakurai K, Yamagami K, Yamashita Y (2009). "Development of Severe Hyponatremia due to Salt-Losing Nephropathy after Esophagectomy for Esophageal Cancer". Case Rep Med. 2009: 241283. doi:10.1155/2009/241283. PMC 2771150. PMID 19888422.