Primary hyperaldosteronism differential diagnosis: Difference between revisions

Latest revision as of 19:31, 25 February 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2]

Overview

Primary hyperaldosteronism must be differentiated from other diseases that cause hypertension and hypokalemia, such as renal artery stenosis, cushing's syndrome, congenital adrenal hyperplasia, Liddle's syndrome, diuretic use, licorice ingestion, and renin-secreting tumors.

Differentiating Primary Hyperaldosteronism from other Diseases

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

Renal artery stenosis
Cushing's syndrome
Congenital adrenal hyperplasia (CAH)
- 17 alpha hydroxylase deficiency
- 11 beta hydroxylase deficiency
Liddle's syndrome
Diuretic use
Licorice ingestion
Renin-secreting tumors

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 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


Differential Diagnoses	Clinical features									History Findings	Laboratory Findings
Differential Diagnoses	Headache and hypertension	Nausea and vomiting	Palpitations	Shortness of breath	Diminished pulses	Fatigue	Constipation	Pruritis	Ambiguous genitalia	History Findings	Laboratory Findings
Renin-Secreting tumors	✔	✔	✔	✔	-	-	-	-	-	Drug-resistant hypertension Chronic headaches	Normal renal function tests Normal liver function tests Metabolic alkalosis (pH > 7.45) Hypokalemia Plasma renin-aldosterone ratio <10
Coarctation of aorta	✔	✔	✔	✔	✔	✔	-	-	-	Young patients (neonates) may have history of: Failure to thrive Poor feeding Lethargy Turner's syndrome Familial predisposition Ventricular septal defects Adults may have a history of: Claudication Epistaxis	Bicuspid aortic valves Notching of ribs Metabolic alkalosis (pH > 7.45) Hyperkalemia Plasma renin-aldosterone ratio <10
11-beta hydroxylase deficiency	✔ (Hypertensive crisis due to increased 11-deoxycorticosterone-11-DOC)	✔	✔	-	-	✔	-	-	✔	Females: Clitoral enlargement Labioscrotal fusion Males: Penile enlargement (If not diagnosed at birth, may present as premature adrenarche, developing body odor with axillary and pubic hair development)	Hypokalemia Increased 11-DOC levels Increased androgens Low urinary aldosterone level
17-alpha hydroxylase deficiency	✔	✔	✔	-	-	-	-	-	✔	Phenotypically females at birth Lack of pubertal development in females Incompletely developed external genitalia in males	Increased serum mineralocorticoids Decreased androgen levels Hypokalemia Low urinary aldosterone level
Uremia		✔	✔	✔	-	✔	✔	✔	-	Patients have chronic kidney disease and maybe on dialysis Features of uremic neuropathy: Autonomic features with postural hypotension, Impaired sweating Diarrhea Impotence Paraesthesia Delayed deep tendon reflexes Muscle wasting Encephalopathy	Increased blood urea nitrogen (BUN) and creatinine (Cr) Hyperkalemia Decreased serum vitamin 1,25 dihydroxy vitamin D3 level
Liddle's syndrome	✔	✔	✔	-	-	-	✔	-	-	Family history of Liddle's syndrome (autosomal dominant inheritance) Nephropathy Arrythmias SCNN1B or SCNN1G gene mutation	Hyporeninemic hypoaldosteronism Hypertension Hypokalemia Enhanced erythrocyte sodium influx Low urinary aldosterone

References

↑ ^1.0 ^1.1 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.
↑ Nielsen ML, Pareek M, Andersen I (2012). "[Liquorice-induced hypertension and hypokalaemia]". Ugeskr. Laeg. (in Danish). 174 (15): 1024–5. PMID 22487411.
↑ 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.
↑ 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.
↑ 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.
↑ 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.
↑ 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.
↑ 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.
↑ 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.
↑ 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.
↑ 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.
↑ 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.
↑ 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.
↑ 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.
↑ 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.

Template:WH Template:WS

[pmid24800505-1] 1.0 ^1.1 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.

[pmid22487411-2] Nielsen ML, Pareek M, Andersen I (2012). "[Liquorice-induced hypertension and hypokalaemia]". Ugeskr. Laeg. (in Danish). 174 (15): 1024–5. PMID 22487411.

[pmid21962616-3] 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.

[pmid22154539-4] 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.

[pmid17275580-5] 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.

[pmid23953804-6] 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.

[pmid25715092-7] 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.

[pmid10818057-8] 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.

[pmid21525970-9] 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.

[pmid25968592-10] 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.

[pmid25908467-11] 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.

[pmid19174076-12] 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.

[pmid3413779-13] 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.

[pmid21494136-14] 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.

[pmid4299011-15] 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.

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@@ Line 1: / Line 1: @@
 __NOTOC__
-{{Conn syndrome}}
+[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Primary_hyperaldosteronism]]
+{{CMG}}; {{AE}} {{HK}}
 ==Overview==
+Primary hyperaldosteronism must be differentiated from other diseases that cause [[hypertension]] and [[hypokalemia]], such as [[renal artery stenosis]], [[cushing's syndrome]], [[congenital adrenal hyperplasia]], [[Liddle's syndrome]], [[diuretic]] use, [[licorice]] ingestion, and [[renin-secreting tumors]].
-==Differebtiating Conn's Syndrome From Other Diseases==
+==Differentiating Primary Hyperaldosteronism from other Diseases==
-Conn's syndrome should be differentiated from other diseases causing hypertension and hypokalemia for example:
+Primary hyperaldosteronism (PA) should be differentiated from other diseases causing '''[[hypertension]]''' and '''[[hypokalemia]]''' for example:<ref name="pmid24800505">{{cite journal |vauthors=Wada N, Jin S, Hui SP, Yanagisawa K, Kurosawa T, Chiba H |title=[Differential diagnosis of primary aldosteronism by measurement of hybrid steroids using mass spectrometry] |language=Japanese |journal=Rinsho Byori |volume=62 |issue=3 |pages=276–82 |year=2014 |pmid=24800505 |doi= |url=}}</ref><ref name="pmid24800505">{{cite journal |vauthors=Wada N, Jin S, Hui SP, Yanagisawa K, Kurosawa T, Chiba H |title=[Differential diagnosis of primary aldosteronism by measurement of hybrid steroids using mass spectrometry] |language=Japanese |journal=Rinsho Byori |volume=62 |issue=3 |pages=276–82 |year=2014 |pmid=24800505 |doi= |url=}}</ref><ref name="pmid22487411">{{cite journal |vauthors=Nielsen ML, Pareek M, Andersen I |title=[Liquorice-induced hypertension and hypokalaemia] |language=Danish |journal=Ugeskr. Laeg. |volume=174 |issue=15 |pages=1024–5 |year=2012 |pmid=22487411 |doi= |url=}}</ref><ref name="pmid21962616">{{cite journal |vauthors=Chow KM, Ma RC, Szeto CC, Li PK |title=Polycystic kidney disease presenting with hypertension and hypokalemia |journal=Am. J. Kidney Dis. |volume=59 |issue=2 |pages=270–2 |year=2012 |pmid=21962616 |doi=10.1053/j.ajkd.2011.08.020 |url=}}</ref><ref name="pmid22154539">{{cite journal |vauthors=Sarafidis PA, Georgianos PI, Germanidis G, Giavroglou C, Nikolaidis P, Lasaridis AN, Madias NE |title=Hypertension and symptomatic hypokalemia in a patient with simultaneous unilateral stenoses of intrarenal arteries and mesangioproliferative glomerulonephritis |journal=Am. J. Kidney Dis. |volume=59 |issue=3 |pages=434–8 |year=2012 |pmid=22154539 |doi=10.1053/j.ajkd.2011.11.001 |url=}}</ref><ref name="pmid17275580">{{cite journal |vauthors=Khosla N, Hogan D |title=Mineralocorticoid hypertension and hypokalemia |journal=Semin. Nephrol. |volume=26 |issue=6 |pages=434–40 |year=2006 |pmid=17275580 |doi=10.1016/j.semnephrol.2006.10.004 |url=}}</ref><ref name="pmid23953804">{{cite journal |vauthors=Weiner ID |title=Endocrine and hypertensive disorders of potassium regulation: primary aldosteronism |journal=Semin. Nephrol. |volume=33 |issue=3 |pages=265–76 |year=2013 |pmid=23953804 |pmc=3748390 |doi=10.1016/j.semnephrol.2013.04.007 |url=}}</ref><ref name="pmid25715092">{{cite journal |vauthors=Martell-Claros N, Abad-Cardiel M, Alvarez-Alvarez B, García-Donaire JA, Pérez CF |title=Primary aldosteronism and its various clinical scenarios |journal=J. Hypertens. |volume=33 |issue=6 |pages=1226–32 |year=2015 |pmid=25715092 |doi=10.1097/HJH.0000000000000546 |url=}}</ref><ref name="pmid10818057">{{cite journal |vauthors=Franse LV, Pahor M, Di Bari M, Somes GW, Cushman WC, Applegate WB |title=Hypokalemia associated with diuretic use and cardiovascular events in the Systolic Hypertension in the Elderly Program |journal=Hypertension |volume=35 |issue=5 |pages=1025–30 |year=2000 |pmid=10818057 |doi= |url=}}</ref><ref name="pmid21525970">{{cite journal |vauthors=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 |title=A clinical phenotype mimicking essential hypertension in a newly discovered family with Liddle's syndrome |journal=Am. J. Hypertens. |volume=24 |issue=8 |pages=930–5 |year=2011 |pmid=21525970 |doi=10.1038/ajh.2011.76 |url=}}</ref><ref name="pmid25968592">{{cite journal |vauthors=Ruecker B, Lang-Muritano M, Spanaus K, Welzel M, l'Allemand D, Phan-Hug F, Katschnig C, Konrad D, Holterhus PM, Schoenle EJ |title=The Aldosterone/Renin Ratio as a Diagnostic Tool for the Diagnosis of Primary Hypoaldosteronism in Newborns and Infants |journal=Horm Res Paediatr |volume=84 |issue=1 |pages=43–8 |year=2015 |pmid=25968592 |doi=10.1159/000381852 |url=}}</ref><ref name="pmid25908467">{{cite journal |vauthors=Ardhanari S, Kannuswamy R, Chaudhary K, Lockette W, Whaley-Connell A |title=Mineralocorticoid and apparent mineralocorticoid syndromes of secondary hypertension |journal=Adv Chronic Kidney Dis |volume=22 |issue=3 |pages=185–95 |year=2015 |pmid=25908467 |doi=10.1053/j.ackd.2015.03.002 |url=}}</ref><ref name="pmid19174076">{{cite journal |vauthors=Iglesias P, Tajada P, Martínez I, Díez JJ |title=[Salt-wasting congenital adrenal hyperplasia associated to hyperreninemic hyperaldosteronism] |language=Spanish; Castilian |journal=Med Clin (Barc) |volume=132 |issue=2 |pages=80–1 |year=2009 |pmid=19174076 |doi=10.1016/j.medcli.2008.09.002 |url=}}</ref><ref name="pmid3413779">{{cite journal |vauthors=Kikuta Y, Sanjo K, Nakajima K, Ashizawa I, Ojima M |title=Primary aldosteronism in childhood due to primary adrenal hyperplasia |journal=Tohoku J. Exp. Med. |volume=155 |issue=1 |pages=57–70 |year=1988 |pmid=3413779 |doi= |url=}}</ref><ref name="pmid21494136">{{cite journal |vauthors=Hassan-Smith Z, Stewart PM |title=Inherited forms of mineralocorticoid hypertension |journal=Curr Opin Endocrinol Diabetes Obes |volume=18 |issue=3 |pages=177–85 |year=2011 |pmid=21494136 |doi=10.1097/MED.0b013e3283469444 |url=}}</ref><ref name="pmid4299011">{{cite journal |vauthors=Bartter FC, Henkin RI, Bryan GT |title=Aldosterone hypersecretion in "non-salt-losing" congenital adrenal hyperplasia |journal=J. Clin. Invest. |volume=47 |issue=8 |pages=1742–52 |year=1968 |pmid=4299011 |pmc=297334 |doi=10.1172/JCI105864 |url=}}</ref>
-*Renal artery stenosis
+*[[Renal artery stenosis]]
-*Cushing's syndrome
+*[[Cushing's syndrome]]
-*Congenital adrenal hyperplasia (CAH)
+*[[Congenital adrenal hyperplasia]] (CAH)
-**17 alpha hydroxylase deficiency
+**[[17 alpha-hydroxylase deficiency|17 alpha hydroxylase deficiency]]
-**11 beta hydroxylase deficiency
+**[[11β-hydroxylase deficiency|11 beta hydroxylase deficiency]]
-*Liddle's syndrome
+*[[Liddle's syndrome]]
-*Diuretic use
+*[[Diuretic]] use
-*Licorice ingestion
+*[[Licorice]] ingestion
-*Renin-secreting tumors
+*[[Renin]]-secreting [[Tumor|tumors]]
-{{familytree/start}}{{familytree | | | | | | | | | A01 | | | | | |A01=Hypertension and Hypokalemia}}
+{{familytree/start}}{{familytree | | | | | | | | | A01 | | | | | |A01=[[Hypertension]] and [[Hypokalemia]]}}
 {{familytree | | | | | | | | | |!| | | | | | | | }}
-{{familytree | | | | | | | | | B01 | | | | | |B01=Plasma renin activity}}
+{{familytree | | | | | | | | | B01 | | | | | |B01=[[Plasma renin activity]]}}
 {{familytree | | |,|-|-|-|-|-|-|^|-|-|-|-|-|-|.| }}
-{{familytree | | C01 | | | | | | | | | | | |C02|C01=Normal or High|C02=Suppressed}}
+{{familytree | | C01 | | | | | | | | | | | |C02|C01=Normal or High (Plasma [[Renin]]/[[Aldosterone]] ratio <10)|C02=Suppressed (Plasma [[Renin]]/[[Aldosterone]] ratio > 20)}}
 {{familytree | | |!| | | | | | | | | | | | | |!| }}
-{{familytree | | D01 | | | | | | | | | | | |D02|D01=Consider other diagnosis|D02=Urinary aldosterone}}
+{{familytree | | D01 | | | | | | | | | | | |D02|D01=• [[Renin-secreting tumors]]<br>• [[Diuretic]] use<br>• [[Renovascular hypertension]]<br>• [[Coarctation of aorta]]<br>• [[Malignant hypertension]]|D02=Urinary [[aldosterone]]}}
 {{familytree | | | | | | | | | | | | |,|-|-|-|+|-|-|-|-|.|}}
 {{familytree | | | | | | | | | | | | E01 | | E02 | | | E03 |E01=Elevated|E02=Normal|E03=Low|}}
 {{familytree | | | | | | | | | | | | |!| | | |!| | | | |!| | }}
-{{familytree | | | | | | | | | | | | F01 | | F02 | | | F03 |F01=Conn's syndrome (Primary aldosteronism)|F02=Profound K+ depletion|F03=• 17 alpha hydroxylase deficiency<br>• 11 beta hydroxylase deficiency<br>• Liddle's syndrome<br>• Licorice ingestion<br>• Deoxycortisone producing tumor|}}
+{{familytree | | | | | | | | | | | | F01 | | F02 | | | F03 |F01=Conn's syndrome (Primary aldosteronism)|F02=Profound [[sodium|K]] depletion|F03=• [[17 alpha hydroxylase deficiency]]<br>• [[11 beta hydroxylase deficiency]]<br>• [[Liddle's syndrome]]<br>• [[Licorice]] ingestion<br>• Deoxycortisone producing tumor|}}
+{{familytree | | | | | | | | | | | | | | | | | | | | | |!| | | | }}
+{{familytree | | | | | | | | | | | | | | | | | | | | |G01|G01=Add Mineralocrticoid antagonist for 8 weeks}}
+{{familytree | | | | | | |,|-|-|-|-|-|-|-|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|-|-|-|-|-|-|-|.}}
+{{familytree | | | | | |H01| | | | | | | | | | | | | | | | | | | | | | | | | | | |H02|H01=[[blood pressure|BP]] response|H02=No [[blood pressure|BP]] response}}
+{{familytree | | | | | | |!| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |!| }}
+{{familytree | | | | | |I01| | | | | | | | | | | | | | | | | | | | | | | | | | | |I02|I01=• [[Deoxycorticosterone]] excess ([[Tumor]], [[17 alpha hydroxylase deficiency|17 alpha hydroxylase]], and [[11 beta hydroxylase deficiency]])<br>• [[Licorice]] ingestion<br>• [[Glucocorticoid]] resistance|I02=[[Liddle's syndrome]]|}}
+{{familytree/end}}
+{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px" align="center"
+|+
+! rowspan="2" style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Differential Diagnoses}}
+! colspan="9" align="center" style="background:#4479BA; color: #FFFFFF; width: 400px;" + | Clinical features
+! rowspan="2" style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|History Findings}}
+! rowspan="2" style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Laboratory Findings}}
+|-
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Headache and hypertension
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Nausea and vomiting
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Palpitations
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Shortness of breath
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Diminished pulses
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Fatigue
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Constipation
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Pruritis
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Ambiguous genitalia
+|-
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Renin-secreting tumors|Renin-Secreting tumors]]
+| style="padding: 5px 5px; background: #F5F5F5;" | ✔
+| style="padding: 5px 5px; background: #F5F5F5;" |<nowiki>✔</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" |✔
+| style="padding: 5px 5px; background: #F5F5F5;" |<nowiki>✔</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" |<nowiki>-</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" |<nowiki>-</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" |<nowiki>-</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" |<nowiki>-</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" |<nowiki>-</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" |
+* Drug-resistant [[hypertension]]
+* Chronic [[Headache|headaches]]
+| style="padding: 5px 5px; background: #F5F5F5;" |
+* Normal [[renal function tests]]
+* Normal [[liver function tests]]
+* [[Metabolic alkalosis]] (pH > 7.45)
+* [[Hypokalemia]]
+* [[Plasma]] [[renin]]-[[aldosterone]] ratio <10
+|-
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Coarctation of aorta]]
+| style="padding: 5px 5px; background: #F5F5F5;" | ✔
+| style="padding: 5px 5px; background: #F5F5F5;" |<nowiki>✔</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" |✔
+| style="padding: 5px 5px; background: #F5F5F5;" |<nowiki>✔</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" |<nowiki>✔</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" |<nowiki>✔</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" | -
+| style="padding: 5px 5px; background: #F5F5F5;" |<nowiki>-</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" |<nowiki>-</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*Young patients ([[neonates]]) may have history of:
+** [[Failure to thrive]]
+** [[Poor feeding]]
+** [[Lethargy]]
+** [[Turner syndrome|Turner's syndrome]]
+** Familial predisposition
+** [[Ventricular septal defects]]
+*Adults may have a history of:
+** [[Claudication]]
+** [[Epistaxis]]
+| style="padding: 5px 5px; background: #F5F5F5;" |
+* [[Bicuspid aortic valves]]
+* Notching of [[ribs]]
+* [[Metabolic alkalosis]] (pH > 7.45)
+* [[Hyperkalemia]]
+* [[Plasma]] [[renin]]-[[aldosterone]] ratio <10
+|-
+| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[11β-hydroxylase deficiency|11-beta hydroxylase deficiency]]
+| style="padding: 5px 5px; background: #F5F5F5;" | ✔ ([[Hypertensive crisis]] due to increased [[11-deoxycorticosterone]]-11-DOC)
+| style="padding: 5px 5px; background: #F5F5F5;" |<nowiki>✔</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" |<nowiki>✔</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" | -
+| style="padding: 5px 5px; background: #F5F5F5;" | -
+| style="padding: 5px 5px; background: #F5F5F5;" |<nowiki>✔</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" | -
+| style="padding: 5px 5px; background: #F5F5F5;" | -
+| style="padding: 5px 5px; background: #F5F5F5;" |✔
+| style="padding: 5px 5px; background: #F5F5F5;" |
+* Females:
+** [[Clitoral body|Clitoral]] enlargement
+** [[Labioscrotal folds|Labioscrotal]] fusion
+* Males:
+** [[Penis|Penile]] enlargement
+* (If not diagnosed at birth, may present as premature [[adrenarche]], developing body odor with [[Axillary hair|axillary]] and [[pubic hair]] development)
+| style="padding: 5px 5px; background: #F5F5F5;" |
+* Hypokalemia
+* Increased 11-DOC levels
+* Increased [[androgens]]
+* Low [[urinary]] [[aldosterone]] level
+|-
+| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[17 alpha-hydroxylase deficiency|17-alpha hydroxylase deficiency]]
+| style="padding: 5px 5px; background: #F5F5F5;" | ✔
+| style="padding: 5px 5px; background: #F5F5F5;" |✔
+| style="padding: 5px 5px; background: #F5F5F5;" |✔
+| style="padding: 5px 5px; background: #F5F5F5;" | -
+| style="padding: 5px 5px; background: #F5F5F5;" | -
+| style="padding: 5px 5px; background: #F5F5F5;" | -
+| style="padding: 5px 5px; background: #F5F5F5;" | -
+| style="padding: 5px 5px; background: #F5F5F5;" | -
+| style="padding: 5px 5px; background: #F5F5F5;" |✔
+| style="padding: 5px 5px; background: #F5F5F5;" |
+* [[Phenotypically]] females at birth
+* Lack of [[pubertal]] development in females
+* Incompletely developed external [[genitalia]] in males
+| style="padding: 5px 5px; background: #F5F5F5;" |
+* Increased [[serum]] [[mineralocorticoids]]
+* Decreased [[androgen]] levels
+* [[Hypokalemia]]
+* Low [[urinary]] [[aldosterone]] level
+|-
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |'''[[Uremia]]'''
+| style="padding: 5px 5px; background: #F5F5F5;" |
+| style="padding: 5px 5px; background: #F5F5F5;" |✔
+| style="padding: 5px 5px; background: #F5F5F5;" |✔
+| style="padding: 5px 5px; background: #F5F5F5;" |✔
+| style="padding: 5px 5px; background: #F5F5F5;" | -
+| style="padding: 5px 5px; background: #F5F5F5;" |✔
+| style="padding: 5px 5px; background: #F5F5F5;" |✔
+| style="padding: 5px 5px; background: #F5F5F5;" |✔
+| style="padding: 5px 5px; background: #F5F5F5;" |<nowiki>-</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" |
+* Patients have [[chronic kidney disease]] and maybe on [[dialysis]]
+* Features of uremic neuropathy:
+** [[Autonomic nervous system|Autonomic]] features with postural [[hypotension]],
+** Impaired [[sweating]]
+** [[Diarrhea]]
+** Impotence
+** [[Paraesthesia]]
+** Delayed [[Deep tendon reflex|deep tendon reflexes]]
+** [[Muscle wasting]]
+** [[Encephalopathy]]
+| style="padding: 5px 5px; background: #F5F5F5;" |
+* Increased [[blood urea nitrogen]] ([[Blood urea nitrogen|BUN]]) and [[creatinine]] ([[Cr]])
+* [[Hyperkalemia]]
+* Decreased [[serum]] [[Vitamin D3|vitamin 1,25 dihydroxy vitamin D3]] level
+|-
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Liddle's syndrome|'''Liddle's syndrome''']]
+| style="padding: 5px 5px; background: #F5F5F5;" |✔
+| style="padding: 5px 5px; background: #F5F5F5;" |✔
+| style="padding: 5px 5px; background: #F5F5F5;" |✔
+| style="padding: 5px 5px; background: #F5F5F5;" |<nowiki>-</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" |<nowiki>-</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" |<nowiki>-</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" |✔
+| style="padding: 5px 5px; background: #F5F5F5;" |<nowiki>-</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" |<nowiki>-</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" |
+* [[Family history]] of [[Liddle's syndrome]] ([[autosomal dominant inheritance]])
+* [[Nephropathy]]
+* [[Arrythmias]]
+* [[SCNN1B]] or [[SCNN1G]] [[gene mutation]]
+| style="padding: 5px 5px; background: #F5F5F5;" |
+* [[Hyporeninemic hypoaldosteronism]]
+* [[Hypertension]]
+* [[Hypokalemia]]
+* Enhanced [[erythrocyte]] [[sodium]] influx
+* Low [[urinary]] [[aldosterone]]
+|}
+==References==
+{{reflist|2}}
 {{WH}}
 {{WS}}
 [[Category:Endocrinology]]
 [[Category:Needs content]]

Primary hyperaldosteronism differential diagnosis: Difference between revisions

Latest revision as of 19:31, 25 February 2019

Overview

Differentiating Primary Hyperaldosteronism from other Diseases

References

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