What should be the focus of the clinical history for suspected secondary hyperaldosteronism?

Updated: Oct 19, 2018
  • Author: George P Chrousos, MD, FAAP, MACP, MACE, FRCP(London); Chief Editor: Robert P Hoffman, MD  more...
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Answer

If secondary hyperaldosteronism is suspected as the cause of hypertension, the history should include questions about flushing, diaphoresis, anxiety attacks, and headaches (pheochromocytoma) and about hematuria and abdominal fullness (Wilms tumor or other renal tumor), in addition to the above symptoms. [31, 32]

For patients in whom secondary hyperaldosteronism is suggested, questions should be specifically directed at potential causes (eg, the presence and duration of swelling, the child’s exercise tolerance).

Information should be sought about a family history of essential hypertension and familial syndromes, including the following:

  • Neurofibromatosis (associated with renal artery stenosis and pheochromocytoma)

  • Multiple endocrine neoplasia (MEN) type 2 – This includes MEN 2A (parathyroid adenoma, medullary thyroid carcinoma [MTC], and pheochromocytoma) and MEN 2B (mucosal neuromas of eyelids, lips, and tongue with a long thin face, pheochromocytoma, and MTC)

  • von Hippel-Lindau syndrome - Cerebellar hemangioblastoma; renal and pancreatic cysts and carcinoma; hemangiomas of the retina, liver, and adrenal glands; and pheochromocytomas


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