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Etiologies of Hypoaldosteronism

Hyporeninemic Hypoaldosteronism (Low Renin, Low Aldosterone)
 - Diabetic Nephropathy 
 - NSAIDs
Non-Hyporeninemic Hypoaldosteronism (Normal
Low Renin, Low Aldosterone ... High Renin, Low Aldosterone ... heparin - Primary adrenal ... Normal or High Aldosterone ... ) - Aldosterone
Hyperaldosteronism - Etiologies of Mineralocorticoid Excess

Primary Hyperaldosteronism (Normal or Low Renin, High Aldosterone) 
 - Aldosterone-secreting
Low Renin, High Aldosterone ... ) - Aldosterone-secreting ... - Congenital adrenal ... High Renin, High Aldosterone ... Normal or Low Aldosterone
Primary vs Secondary Adrenal Insufficiency - Pathophysiology
Primary AI = adrenal glands themselves are the problem. This
Primary vs Secondary Adrenal ... Pathophysiology Primary AI = adrenal ... means cortisol AND aldosterone ... leads to limited adrenal ... Aldosterone & Renin
Causes of Metabolic Alkalosis - Differential Diagnosis Algorithm
GI Losses - Gastric
 • Vomiting
 • NG suction
GI
Chloridorrhea Renal ... High Renin, High Aldosterone ... Low Renin, High Aldosterone ... • Aldosterone-secreting ... mass • Adrenal
Drugs causing hyperkalemia
 • Impaired release of renin: NSAIDs, Beta blockers, Cyclosporine, tacrolimus, Diabetes, Elderly
 •
blockers • Impaired aldosterone ... mechanism: Adrenal ... Pentamidine • Aldosterone
The Sympatho-Adrenal Response to Shock

Showing the effect of increased catecholamines on the left of the diagram
The Sympatho-Adrenal ... angiotensin and aldosterone ... #Sympathetic #Adrenal
Malignant Adrenal Mass - Differential Diagnosis Algorithm
Suggestive of Malignancy: Inhomogenous Density, Delay in CT Contrast Washout
Malignant Adrenal ... Syndrome, Congenital Adrenal ... /Alkalosis • Aldosterone ... Carcinoma (High Aldosterone ... Often Bilateral) Adrenal
Causes of Secondary Hypertension - Differential Diagnosis and Screening Testing
Common causes: 
 • Renal parenchymal disease
aldosteronism - Plasma aldosterone ... withdrawal of aldosterone ... with 24-h urine aldosterone ... test with plasma aldosterone ... CT scan, adrenal
Primary Adrenal Insufficiency:
 • ACTH stimulation test - Synthetic ACTH does not stimulate cortisol secretion because
Primary Adrenal ... dysfunctional adrenal ... absent • Plasma aldosterone ... both cortisol and aldosterone ... pituitary • Plasma aldosterone
Benign Adrenal Mass - Differential Diagnosis Algorithm
Hyperplasia - Often Bilateral
 • Congenital Adrenal Hyperplasia
 • ACTH
Benign Adrenal Mass ... • Congenital Adrenal ... Suppression Test) Aldosterone ... /Alkalosis • Aldosterone