What should be included in the exam for 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

Examination of the hypertensive patient should include the following:

  • General examination – Be alert for dysmorphic features (eg, MEN 2B), evidence of neurofibromatosis type 1 (NF-1; ie, café-au-lait lesions, axillary freckling, short stature, and evidence of disease in parents), and features of Cushing syndrome (ie, obesity, short stature, striae, and hirsutism)

  • Neck examination – Assess for a thyroid mass (MTC associated with MEN 2)

  • Cardiovascular examination - Assess left ventricular muscle mass and exclusion of murmurs and pulse differential (eg, coarctation of the aorta); check for abdominal bruits (renal artery stenosis) and peripheral edema (secondary hyperaldosteronism)

  • Abdominal examination – Look for masses (Wilms tumor), hepatomegaly (cardiac failure or liver disease), splenomegaly, and ascites

  • Neurologic examination - Examine the eyes, and assess visual acuity (severe hypertension may interfere with vision); examine the eye grounds (looking for retinal angiomas [von Hippel-Lindau syndrome]); be alert for hypertensive retinopathy, which is of prognostic significance, including arterial narrowing, hemorrhages, cotton-wool spots, and papilledema; assess for Lisch nodules of the iris (NF-1)

  • Strength assessment - Evaluation for weakness, focal neurologic signs, or impaired conscious state in a patient with severe hypertension, which requires urgent treatment and central nervous system (CNS) imaging to exclude infarction or hemorrhage

  • Skin examination - In patients who have secondary hyperaldosteronism, look for evidence of NF-1


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