Internal Medicine

0521779407-14 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:16

988 Mineralocorticoid Disorders

➣Cushing’s syndrome (esp. associated with ectopic ACTH)

➣Congenital adrenal hyperplasia

➣Barter’s syndrome

➣Gittelman’s syndrome

➣Renovascular or malignant hypertension

➣Diuretics, diarrhea, vomiting

➣CHF, nephrotic syndrome, cirrhosis

➣Inhibitors of 11-beta-hydroxysteroid dehydrogenase II (e.g., car-

benoxone, licorice)

■Mineralocorticoid deficiency:

➣Primary hypoaldosteronism; heparin-induced

➣Congenital adrenal hyperplasia

➣Primary adrenal insufficiency

➣Chronic interstitial nephritis with mild renal insufficiency

➣Renal failure

➣Medications: NSAIDs, ACE inhibitors, cyclosporine, amiloride,

spironolactone, triamterene, trimethoprim, pentamidine

➣Pseudohypoaldosteronism

management

What to Do First

■Normalize serum potassium

■Discontinue confounding medications

General Measures

■Exclude common causes

■Evaluate laboratory data in context of dietary salt intake

■Use PRA to distinguish primary vs secondary disorders

■Confirm, establish cause

■Treat hypertension

■Restrict salt in mineralocorticoid excess

■Liberalize salt in mineralocorticoid deficiency

specific therapy

■Mineralocorticoid excess: amiloride, spironolactone, triamterene;

dexamethasone for glucocorticoid-remediable hyperaldosteronism

(rare); surgery indicated for unilateral adenoma

■Mineralocorticoid deficiency: thiazide or furosemide for mild sec-

ondary causes; fludrocortisone

■Side Effects & Contraindications

➣Mineralocorticoid excess: hyperkalemia, gynecomastia, impo-

tence, rash, liver function abnormalities