At a Glance Pseudohypoaldosteronism (PHA) is a rare inherited disorder in which there is impaired response to aldosterone. There are two types of PHA that have very different presentations. Type I PHA usually presents soon after birth. Similar to mineralocorticoid deficiency, there is volume contraction, hyponatremia, hyperkalemia, and renal salt wasting. Blood pressure is low…
At a Glance Secondary and tertiary adrenal insufficiency may present with nonspecific symptoms of fatigue, weakness, and hypoglycemia. Suspicion of secondary adrenal insufficiency may be raised by a low serum cortisol level or a history of long-term steroid therapy, head trauma, head irradiation, pituitary tumors, pituitary surgery, or other processes that may impair the hypothalamic-pituitary-adrenal…
At a Glance Primary aldosteronism often presents as hypertension that is relatively resistant to antihypertensive medications. The cause of hypertension in most patients is unknown (essential hypertension); however, a need for further evaluation of hypertension and the possibility of primary aldosteronism is suggested by several factors: moderate or extreme hypertension diastolic hypertension resistance to therapy…
At a Glance Bilateral hyperplasia is one cause of primary aldosteronism (also sometimes referred to as primary hyperaldosteronism). Other causes are adrenal adenomas, adrenal carcinoma, and inherited glucocorticoid responsive aldosteronism. Bilateral hyperplasia often presents as hypertension relatively resistant to antihypertensive medications. The cause of hypertension in most patients is unknown (essential hypertension), but several factors…
At a Glance Suspicion of secondary hyperaldosteronism is raised by moderate to severe hypertension that is relatively unresponsive to therapy, combined with evidence of renovascular disorders or diagnoses that may be associated with renovascular disorders. Abdominal bruits serve as a clinical sign of vascular stenosis. Difference in kidney size or unexplained renal insufficiency also raises…
At a Glance Presentation with symptoms of mild volume depletion, such as decreased blood pressure and postural hypotension together with hyperkalemia and hyponatremia, are suggestive of primary hypoaldosteronism. This disorder results from injury or genetic defects in adrenal cells producing aldosterone. Hypoaldosteronism can occur as part of the presentation of Addison’s disease, resulting from destruction…
At a Glance Hyperkalemia and hyperchloremic metabolic acidosis in patients with chronic kidney disease should lead to suspicion of secondary hypoaldosteronism. The juxtaglomerular apparatus in the kidney is the source of production of renin. Consequently, injury to the juxtaglomerular apparatus in kidney disease can impair the production of renin and decrease activation of the renin-angiotensin-aldosterone…
At a Glance Pseudoaldosteronism (sometimes also referred to as pseudohyperaldosteronism) clinically presents similarly to primary aldosteronism (see chapter on primary aldosteronism with hypertension, hypokalemia, and metabolic alkalosis. However, pseudohyperaldosteronism differs by having low plasma aldosterone. There are several potential causes of pseudohyperaldosteronism: ingestion of licorice-containing candy, herbal preparations, teas, or chewing tobacco excess of glucocorticoids…
