Isolated hypoaldosteronism: An overlooked cause of hyponatraemia

Talapatra, Indrajit; Kalavalapalli, Shyam; Tymms, D J

doi:10.1016/j.ejim.2006.09.026

Cited by 7 publications

(4 citation statements)

References 3 publications

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“…Our results clearly indicate that not only can HH develop in isolated hypoaldosteronism, moreover, it is frequent. Furthermore, our review of prior studies on patients with isolated hypoaldosteronism (13,29,(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53) indicates that the detection of HH is not limited to the current study, although the total number of subjects included in these investigations was smaller, with a finding of HH in 11 of 28 patients in the largest series (29).…”

Section: Discussionmentioning

confidence: 79%

Clinical manifestations and associated factors in acquired hypoaldosteronism in endocrinological practice

et al. 2022

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IntroductionHypoaldosteronism can be congenital or acquired, isolated or part of primary adrenal insufficiency, and caused by an aldosterone deficit, resistance, or a combination of both. Reduced mineralocorticoid action can induce a decrease in urine K+ and H+ excretion and an increase in urine Na+ excretion, leading to hyperkalemia, and/or hyponatremia, often combined with metabolic acidosis. We aimed to characterize the clinical manifestations of hypoaldosteronism, and their associated factors.MethodsRetrospective analysis of 112 episodes of hypoaldosteronism diagnosed in 86 adult patients from 2012-2019 by the Endocrinology and Nutrition Department of a tertiary hospital. The frequency of hyperkalemia, hypovolemic hyponatremia (HH) and metabolic acidosis (MA), and their associated factors were evaluated.ResultsPatients had a median age of 77 [65 – 84], 55.4% were male. 94.6% cases showed hyperkalemia, 54.5% HH, and 60.3% MA. The mean serum K+ of all cases was 5.4 ± 0.5 mmol/L, Na+: 132.1 ± 6.3 mmol/L, HCO3: 22.6 ± 3.3 mmol/L. Hypoaldosteronism was isolated in the majority of cases: only 6/112 (5%) had primary adrenal insufficiency. Hypovolemia was associated with hyponatremia and a more florid clinical presentation. HH was associated with a combined presence of aldosterone-lowering and mineralocorticoid resistance factors. MA was associated with the presence of mineralocorticoid resistance factors.ConclusionsHypoaldosteronism in adult endocrinological clinical practice is primarily isolated, and acquired. It predisposes not only to the development of hyperkalemia and MA, but also to that of HH. Hypoaldosteronism must be considered in the differential diagnosis of HH with urinary sodium wasting.

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Section: Discussionmentioning

confidence: 79%

Clinical manifestations and associated factors in acquired hypoaldosteronism in endocrinological practice

et al. 2022

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“…45,46 Hypoaldosteronism can be detected in up to 3.8% of hospitalized patients, 47 the majority between 60 and 80 years of age. Patients typically present with hyperkalaemia alone, yet when hypovolaemia is present, AVP elevation can induce hyponatraemia.…”

Section: Physical Examinationmentioning

confidence: 99%

Hyponatraemia in older patients: a clinical and practical approach

Rünkle

Gómez-Hoyos

Cuesta-Hernandez

et al. 2015

Rev. Clin. Gerontol.

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Hyponatraemia is frequent in older people and induces marked motor and cognitive dysfunction, even in patients deemed 'asymptomatic'. Nutritional status is worse than in euvolaemic-matched controls, and the risk of fracture is increased following incidental falls. Yet hyponatraemia is undertreated, in spite of the fact that its correction is accompanied by a clear improvement in symptoms. Both evaluation of neurological symptoms and classification by volaemia are essential for a correct diagnosis and treatment of the hyponatraemic elderly patient. The syndrome of inappropriate anti-diuretic hormone secretion (SIADH) is the most common cause of hyponatraemia in older people. Nutritional status and chronicity of SIADH should be taken into account when deciding therapy. We propose an 8-step approach to the management of the elderly patient with hyponatraemia.

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“…Our findings are in accordance with a previous study of hypoaldosteronism, where elements known to interfere with mineralocorticoid physiology were also associated with HH ( 6 ) when compared to a group comprised of episodes of euvolemic hyponatremia as well as hyperkalemic non-hyponatremic episodes. Therefore, it appears that hypoaldosteronism itself can readily induce hypovolemic hyponatremia, justifying observations of hyponatremia in prior case series of this disorder ( 9 , 10 , 12 , 13 , 15 , 16 , 17 , 45 , 46 ).…”

Section: Discussionmentioning

confidence: 75%

“…Hyperkalemia is not a constant of hypoaldosteronism, yet is often considered to be its sole electrolytic manifestation. However, prior series ( 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ), including the first case reported by Hudson et al ( 23 ), detected the presence of hyponatremia in this condition. We have recently reported that HH is not infrequent in isolated acquired hypoaldosteronism, particularly when both factors inducing a low circulating level of aldosterone (such as heparin administration) and factors resulting in a resistance to mineralocorticoid action (such as trimethoprim therapy) coincide ( 6 ).…”

Section: Introductionmentioning

confidence: 84%

Isolated hypoaldosteronism is a cause of hypovolemic but not euvolemic hyponatremia

Ruiz-Sánchez,

Calle-Pascual,

Rubio-Herrera

et al. 2024

Endocrine Connections

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INTRODUCTION. Hypoaldosteronism is characterized by hyperkalemia, and/or hypovolemic hyponatremia (HH), often accompanied by metabolic acidosis. HH is typical of hypoaldosteronism, whereas euvolemic hyponatremia (EH) is not. The purpose of the current study is to describe the characteristics of hyponatremia in hypoaldosteronism, and elucidate whether EH can be considered part the disease’s spectrum. METHODS. In a hypoaldosteronism cohort, we analyzed the factors associated with hyponatremia, comparing the characteristics of EH and HH and their associated factors. Correlation analyses of mineralocorticoid biomarkers, such as the transtubular potassium gradient (TTKG), and the urinary Na+/K+ ratio (UNa+/UK+) with serum and urinary electrolytes were performed in both types of hyponatremia. RESULTS. Of 112 hypoaldosteronism episodes, 77.7% were ≥ 65 years old, 44.6% were women and 80 (71.4%) had hyponatremia. Hyponatremia was negatively associated with the presence of chronic kidney disease, and positively with a hypovolemic state, malnutrition, a prior history of hyponatremia and glucocorticoid therapy. HH: 61/80 and EH: 19/80 episodes. HH was associated with an age ≥ 65 years and the use of diuretics, as well as factors related to an aldosterone deficit and/or mineralocorticoid resistance. In HH, but not in EH, urinary potassium was correlated with the TTKG, and urinary sodium with both the TTKG and the UNa+/UK+. CONCLUSION: Both HH and EH can be observed in hypoaldosteronism. However, only the former would be related to insufficient mineralocorticoid activity.

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Isolated hypoaldosteronism: An overlooked cause of hyponatraemia

Cited by 7 publications

References 3 publications

Clinical manifestations and associated factors in acquired hypoaldosteronism in endocrinological practice

Clinical manifestations and associated factors in acquired hypoaldosteronism in endocrinological practice

Hyponatraemia in older patients: a clinical and practical approach

Isolated hypoaldosteronism is a cause of hypovolemic but not euvolemic hyponatremia

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