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, hypoaldosteronism can progress to hyperkalemia, hyponatremia, metabolic acidosis with hypo or hyper-volemia. Common complications of hypoaldosteronism include hyperkalemia, metabolic acidosis, hypotension, hypovolemia and hyponatremia.

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

• 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.