Diagnostic Tests for Primary Hyperaldosteronism
Primary Hyperaldosteronism Tests: Book Excerpts
- DIAGNOSTIC WORKUP - ALKALOSIS (INCREASED PH)
- History and physical examination - Weight gain, excessive
- History and physical examination - Muscle weakness
- History and physical examination - Weight loss, excessive
- History and physical examination - Gait, steppage [Equine gait, paretic gait, prancing gait, weak gait]
- History and physical examination - Weight gain, excessive
- History and physical examination - Muscle weakness
- History and physical examination - Weight loss, excessive
- History and physical examination - Gait, steppage [Equine gait, paretic gait, prancing gait, weak gait]
- Physical assessment - Weight gain, excessive
- Physical assessment - Muscle weakness
- Physical assessment - Weight loss, excessive
- Diagnostic Approach - Hypotonia and Weakness
- History and physical examination - Weight gain, excessive
- History and physical examination - Muscle weakness
- History and physical examination - Weight loss, excessive
- History and physical examination - Gait, steppage [Equine gait, paretic gait, prancing gait, weak gait]
Primary Hyperaldosteronism Diagnosis: Book Excerpts
- Ask the following questions - ALKALOSIS (INCREASED PH)
- Differential Diagnosis - Muscle Weakness – Proximal
- Differential Diagnosis - Muscle Weakness – Distal
- Approach to the Diagnosis - ALKALOSIS (INCREASED PH)
- History and physical examination - Weight gain, excessive
- History and physical examination - Muscle weakness
- History and physical examination - Weight loss, excessive
- History and physical examination - Gait, steppage [Equine gait, paretic gait, prancing gait, weak gait]
- Diagnosis - Hyperaldosteronism
- History and physical examination - Weight gain, excessive
- History and physical examination - Muscle weakness
- History and physical examination - Weight loss, excessive
- History and physical examination - Gait, steppage [Equine gait, paretic gait, prancing gait, weak gait]
- Diagnosis - Hyper-aldosteronism
- History - Weight gain, excessive
- History - Muscle weakness
- History - Weight loss, excessive
- Clinical Features and Diagnosis - Hypotonia and Weakness
- History and physical examination - Weight gain, excessive
- History and physical examination - Muscle weakness
- History and physical examination - Weight loss, excessive
- History and physical examination - Gait, steppage [Equine gait, paretic gait, prancing gait, weak gait]
- Approach to the Diagnosis - ALKALOSIS (INCREASED pH)
Diagnostic Tests for Primary Hyperaldosteronism: Online Medical Books
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ALKALOSIS (INCREASED PH):
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
The workup of alkalosis should include a CBC, chemistry panel, urinalysis, electrolytes, arterial blood gas analysis, flat plate of the abdomen, chest x-ray, and consultation with an endocrinologist.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Weight gain, excessive:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
Determine your patient’s previous patterns of weight gain and loss. Does he have a family history of obesity, thyroid disease, or diabetes mellitus? Assess his eating and activity patterns. Has his appetite increased? Does he exercise regularly or at all? Next, ask about associated symptoms. Has he experienced visual disturbances, hoarseness, paresthesia, or increased urination and thirst? Has he become impotent? If the patient is female, has she had menstrual irregularities or experienced weight gain during menstruation?
Form an impression of the patient’s mental status. Is he anxious or depressed? Does he respond slowly? Is his memory poor? What medications is he using?
During your physical examination, measure skin-fold thickness to estimate fat reserves. (See Evaluating nutritional status, pages 644 and 645.) Note fat distribution and the presence of localized or generalized edema and overall nutritional status. Inspect for other abnormalities, such as abnormal body hair distribution or hair loss and dry skin. Take and record the patient’s vital signs.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Muscle weakness:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
Begin by determining the location of the patient’s muscle weakness. Ask if he has difficulty with specific movements such as rising from a chair. Find out when he first noticed the weakness; ask him whether it worsens with exercise or as the day progresses. Also ask about related symptoms, especially muscle or joint pain, altered sensory function, and fatigue.
Obtain a medical history, noting especially chronic disease, such as hyperthyroidism; musculoskeletal or neurologic problems, including recent trauma; a family history of chronic muscle weakness, especially in males; and alcohol and drug use.
Focus your physical examination on evaluating muscle strength. Test all major muscles bilaterally. (See Testing muscle strength, pages 418 and 419.) When testing, make sure that the patient’s effort is constant; if it isn’t, suspect pain or other reluctance to make the effort. If the patient complains of pain, ease or discontinue testing and have him try the movements again. Remember that the patient’s dominant arm, hand, and leg are somewhat stronger than their nondominant counterparts. Besides testing individual muscle strength, test for range of motion (ROM) at all major joints (shoulder, elbow, wrist, hip, knee, and ankle). Also test sensory function in the involved areas, and test deep tendon reflexes (DTRs) bilaterally.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Weight loss, excessive:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
Begin with a thorough diet history because weight loss almost always is caused by inadequate caloric intake. If the patient hasn’t been eating properly, try to determine why. Ask him about previous weight and if the recent loss was intentional. Be alert to lifestyle or occupational changes that may be a source of anxiety or depression. For example, has he gotten separated or divorced? Has a family member or friend died recently? Has he recently changed jobs?
Inquire about recent changes in bowel habits, such as diarrhea or bulky, floating stools. Has the patient had nausea, vomiting, or abdominal pain, which may indicate a GI disorder? Has he had excessive thirst, excessive urination, or heat intolerance, which may signal an endocrine disorder? Take a careful drug history, noting especially any use of diet pills and laxatives.
Carefully check the patient’s height and weight, and ask about his previous weight. Take his vital signs and note his general appearance: Is he well nourished? Do his clothes fit? Is muscle wasting evident? Ask about exact weight changes (with approximate dates).
Next, examine the patient’s skin for turgor and abnormal pigmentation, especially around the joints. Does he have pallor or jaundice? Examine his mouth, including the condition of his teeth or dentures. Look for signs of infection or irritation on the roof of the mouth, and note any hyperpigmentation of the buccal mucosa. Also, check the patient’s eyes for exophthalmos and his neck for swelling; evaluate his lungs for adventitious sounds. Inspect his abdomen for signs of wasting, and palpate for masses, tenderness, and an enlarged liver.
Conventional laboratory and radiologic investigations such as complete blood count, serum albumin levels, urinalysis, chest X-ray, and upper GI series usually reveal the cause. Almost all physical causes are clinically evident during the initial evaluation. Cancer, GI disorders, and depression are the most common pathologic causes.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Gait, steppage [Equine gait, paretic gait, prancing gait, weak gait]:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
Begin by asking the patient about the onset of the gait and recent changes in its character. Does a family member have a similar gait? Find out if the patient has had a traumatic injury to the buttocks, hips, legs, or knees. Ask about a history of chronic disorders that may be associated with polyneuropathy, such as diabetes mellitus, polyarteritis nodosa, and alcoholism. While you’re taking the history, observe whether the patient crosses his legs while sitting because this may put pressure on the peroneal nerve.
Inspect and palpate the patient’s calves and feet for muscle atrophy and wasting. Using a pin, test for sensory deficits along the entire length of both legs.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Weight gain, excessive:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Determine your patient’s previous patterns of weight gain and loss. Does he have a family history of obesity, thyroid disease, or diabetes mellitus? Assess his eating and activity patterns. Has his appetite increased? Does he exercise regularly or at all? Next, ask about associated symptoms. Has he experienced visual disturbances, hoarseness, paresthesia, or increased urination and thirst? Has he become impotent? If the patient is female, has she had menstrual irregularities or experienced weight gain during menstruation?
Form an impression of the patient’s mental status. Is he anxious or depressed? Does he respond slowly? Is his memory poor? What medications is he using?
During your physical examination, measure skin-fold thickness to estimate fat reserves. (See Evaluating nutritional status.) Note fat distribution, the presence of localized or generalized edema, and overall nutritional status. Examine the patient for other abnormalities, such as abnormal body hair distribution or hair loss and dry skin. Take and record the patient’s vital signs.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Muscle weakness:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Begin by determining the location of the patient’s muscle weakness. Ask if he has difficulty with specific movements, such as rising from a chair. Find out when he first noticed the weakness; ask him whether it worsens with exercise or as the day progresses. Also ask about related symptoms, especially muscle or joint pain, altered sensory function, and fatigue.
Obtain a medical history, noting especially chronic disease such as hyperthyroidism; musculoskeletal or neurologic problems, including recent trauma; family history of chronic muscle weakness, especially in males; and alcohol and drug use.
Focus your physical examination on evaluating muscle strength. Test all major muscles bilaterally. (See Testing muscle strength, pages 530 and 531.) When testing, make sure the patient’s effort is constant; if it isn’t, suspect pain or other reluctance to make the effort. If the patient complains of pain, ease or discontinue testing and have him try the movements again. Remember that the patient’s dominant arm, hand, and leg are somewhat stronger than their nondominant counterparts. Besides testing individual muscle strength, test for range of motion at all major joints (shoulder, elbow, wrist, hip, knee, and ankle). Also test sensory function in the involved areas, and test deep tendon reflexes bilaterally.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Weight loss, excessive:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Begin with a thorough diet history because weight loss is almost always caused by inadequate caloric intake. If the patient hasn’t been eating properly, try to determine why. Ask about his previous weight and whether the recent loss was intentional. Be alert for lifestyle or occupational changes that may be causing anxiety or depression. For example, has he gotten separated or divorced? Has he recently changed jobs?
Inquire about recent changes in bowel habits, such as diarrhea or bulky, floating stools. Has the patient had nausea, vomiting, or abdominal pain, which may indicate a GI disorder? Has he had excessive thirst, excessive urination, or heat intolerance, which may signal an endocrine disorder? Take a careful drug history, noting especially the use of diet pills or laxatives.
Carefully check the patient’s height and weight, and ask about exact weight changes with approximate dates. Take his vital signs and note his general appearance: Is he well nourished? Do his clothes fit? Is muscle wasting evident?
Next, examine the patient’s skin for turgor and abnormal pigmentation, especially around the joints. Does he have pallor or jaundice? Examine his mouth, including the condition of his teeth or dentures. Look for signs of infection or irritation on the roof of the mouth, and note any hyperpigmentation of the buccal mucosa. Also, check the patient’s eyes for exophthalmos and his neck for swelling; auscultate his lungs for adventitious sounds. Inspect his abdomen for signs of wasting, and palpate for masses, tenderness, and an enlarged liver.
Conventional laboratory and radiologic tests, such as complete blood count, serum albumin levels, urinalysis, chest
X-rays, and upper GI series, usually reveal the cause. Almost all physical causes are clinically evident during the initial evaluation. Cancer, GI disorders, and depression are the most common pathologic causes.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Gait, steppage [Equine gait, paretic gait, prancing gait, weak gait]:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Begin by asking the patient about the onset of the gait and any recent changes in its character. Does any family member have a similar gait? Find out if the patient has had any traumatic injury to the buttocks, hips, legs, or knees. Ask about a history of chronic disorders that may be associated with polyneuropathy, such as diabetes mellitus, polyarteritis nodosa, and alcoholism. While you’re taking the history, observe whether the patient crosses his legs while sitting because this may put pressure on the peroneal nerve.
Inspect and palpate the patient’s calves and feet for muscle atrophy and wasting. Using a pin, test for sensory deficits along the entire length of both legs.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Weight gain, excessive:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
During your physical assessment, measure skin-fold thickness to estimate fat reserves. (See Evaluating nutritional status, pages 710 and 711.) Note fat distribution and the presence of localized or generalized edema and overall nutritional status. Inspect for other abnormalities, such as abnormal body hair distribution or hair loss and dry skin. Take and record the patient’s vital signs.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Muscle weakness:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Focus your physical assessment on evaluating muscle strength. Test all major muscles bilaterally. (See Testing muscle strength, pages 428 and 429.)
When testing, make sure the patient’s effort is constant; if it isn’t, suspect pain or other reluctance to make the effort. If the patient complains of pain, ease or discontinue testing and have him try the movements again. Remember that the patient’s dominant arm, hand, and leg are somewhat stronger than their nondominant counterparts. Besides testing individual muscle strength, test for range of motion (ROM) at all major joints (shoulder, elbow, wrist, hip, knee, and ankle). Also test sensory function in the involved areas, and test deep tendon reflexes (DTRs) bilaterally.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Weight loss, excessive:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Carefully check the patient’s height and weight. Ask about his previous weight. Take his vital signs and note his general appearance: Is he well nourished? Do his clothes fit? Is muscle wasting evident? Ask about exact weight changes (with approximate dates).
Next, examine the patient’s skin for turgor and abnormal pigmentation, especially around the joints. Does he have pallor or jaundice? Examine his mouth, including the condition of his teeth or dentures. Look for signs of infection or irritation on the roof of the mouth, and note any hyperpigmentation of the buccal mucosa. Also check the patient’s eyes for exophthalmos and his neck for swelling; evaluate his lungs for adventitious sounds. Inspect his abdomen for signs of wasting, and palpate for masses, tenderness, and an enlarged liver.
Conventional laboratory and radiologic investigations, such as complete blood count, serum albumin levels, urinalysis, chest X-ray, and upper GI series usually reveal the cause of weight loss.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Hypotonia and Weakness:
Diagnostic Approach
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
First stepis to determine whether disorder involves nervous system includingneuromuscular system. This can usually be accomplished by historyand physical exam.If disorder involves nervous system,next step is to define anatomic level of abnormality—brain,spinal cord, anterior horn cell, peripheral nerve, neuromuscularjunction, or muscle. This can usually be accomplished by consideringdistinguishing features (e.g., pattern of weakness, deep tendonreflexes, presence of sensory loss or fasciculations, serum muscleenzyme levels, CSF findings, electromyographic pattern, nerve conductionvelocities, and muscle biopsy).Final step is to make specific diagnosis,which usually can be done by analysis of the above findings, otherclinical findings, and other investigations. Brain
Characteristicfindings with brain disorders include weakness of extremities (proximalas much as or more than distal), normal or increased deep tendonreflexes, seizures, developmental delay, and cognitive change.Degree of weakness is usually lessstriking than degree of hypotonia. Cranial nerve nuclei also maybe involved.Serum muscle enzymes, electromyography,and muscle biopsy are normal, except for particular disorders (e.g.,congenital muscle dystrophies) in which muscle and brain may beabnormal.Neuroimaging is useful in diagnosisof many of these disorders. Spinal Cord
Disordersaffecting spinal cord may produce flaccid weakness of all extremitiesif injury involves cervical region; usually normal or hypoactivedeep tendon reflexes, which can become hyperactive in next few weeksor months; sphincter abnormalities; and sensory level on trunk.Cranial nerve function is normal.MRI is useful in defining locationand extent of spinal cord lesion. Anterior Horn Cell
Characteristicfindings of spinal muscular atrophies include severe hypotonia and weakness(proximal as much as or more than distal), muscle fasciculations,and absence of deep tendon reflexes. Facial weakness also may occur.Sensory function, spinal fluid analysis, and serum muscle enzymelevels are normal.Fibrillations can be demonstrated byelectromyography.Muscle biopsy shows denervation patternin which hallmark is atrophy of group of muscle fibers. Enteroviralinfection affecting anterior horn cells commonly produces asymmetricweakness and abnormal spinal fluid. Peripheral Nerve
Characterizedby marked weakness (usually distal more than proximal), decreasedor absent deep tendon reflexes, abnormal sensory examination, increasedcerebrospinal fluid protein concentration, and decreased nerve conductionvelocities.Muscle biopsy shows denervation pattern,and nerve biopsy is usually abnormal. Neuromuscular Junction
Disordersof neuromuscular junction produce generalized weakness (proximalas much as distal). Facial weakness is usual finding, and extraocularmuscles may be involved. Deep tendon reflexes are usually normal.Sensory function, spinal fluid analysis, serum muscle enzyme levels,and muscle biopsy are normal.Electromyography shows characteristicdecremental response to repetitive stimulation with myasthenia gravis.There is usually positive response to neostigmine or edrophonium.Typical electromyographic findingsin botulism are incremental response with repetitive stimulationand frequent, brief duration, small amplitude motor unit potentials.Pupillary responses to light are impaired or absent with botulism. Muscle
Muscle disordersproduce weakness, with proximal weakness often more pronounced thandistal weakness. Facial weakness is variable but may occur withseveral muscle disorders. These include central core disease, myotubularmyopathy, nemaline myopathy, congenital fiber disproportion, congenitalmuscular dystrophy, facioscapulohumeral dystrophy, and myotonicdystrophy. Deep tendon reflexes are usually decreased in proportionto weakness.Sensory function and spinal fluid analysisare normal. Increased serum concentration of muscle enzymes is variable.Electromyography shows small-amplitude,short-duration motor unit potentials and myopathic polyphasic potentials.Muscle biopsy shows myopathic pattern,and nongrouped atrophy is essential feature.Various studies of muscle (histologic,histochemical, biochemical, immunocytochemical, electron microscopic)are often needed for diagnosis.Molecular genetic analysis can nowbe performed for definitive diagnosis of many muscle disorders.
» READ BOOK EXCERPT ONLINE »
Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Weight gain, excessive:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Determine your patient's previous patterns of weight gain and loss. Does he have a family history of obesity, thyroid disease, or diabetes mellitus? Assess his eating and activity patterns. Has his appetite increased? Does he exercise regularly or at all? Ask about associated symptoms. Has the patient experienced vision disturbances, hoarseness, paresthesia, or increased urination and thirst? Has he become impotent? If the patient is female, has she had menstrual irregularities or experienced weight gain during menstruation? Is she menopausal or postmenopausal?
Form an impression of the patient's mental status. Is he anxious or depressed? Does he respond slowly? Is his memory poor? What medications is he taking?
During your physical examination, measure skin-fold thickness to estimate fat reserves. (See Evaluating nutritional status, pages 644 and 645.) Note fat distribution and the presence of localized or generalized edema and overall nutritional status. Inspect for other abnormalities, such as abnormal body hair distribution or hair loss and dry skin. Take and record the patient's vital signs.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Muscle weakness:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Begin by determining the location of the patient's muscle weakness. Ask if he has difficulty with specific movements such as rising from a chair. Find out when he first noticed the weakness; ask him whether it worsens with exercise or as the day progresses. Also ask about related symptoms, especially muscle or joint pain, altered sensory function, and fatigue.
Obtain a medical history, noting especially chronic disease, such as hyperthyroidism; musculoskeletal or neurologic problems, including recent trauma; a family history of chronic muscle weakness, especially in males; and alcohol and drug use.
Focus your physical examination on evaluating muscle strength. Test all major muscles bilaterally. (See Testing muscle strength, pages 410 and 411.) When testing, make sure that the patient's effort is constant; if it isn't, suspect pain or other reluctance to make the effort. If the patient complains of pain, ease or discontinue testing and have him try the movements again. Remember that the patient's dominant arm, hand, and leg are somewhat stronger than their nondominant counterparts. Besides testing individual muscle strength, test for range of motion (ROM) of all major joints (such as shoulder, elbow, wrist, hip, knee, and ankle). Also test sensory function in the involved areas, and test deep tendon reflexes (DTRs) bilaterally.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Weight loss, excessive:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Begin with a thorough diet history because weight loss is almost always caused by inadequate caloric intake. If the patient hasn't been eating properly, try to determine why. Ask him about previous weight and whether the recent loss was intentional. Determine how long the weight loss has been taking place. Be alert to lifestyle or occupational changes that may be a source of anxiety or depression. Has the patient recently experienced a loss?
Inquire about recent changes in bowel habits, such as diarrhea or bulky, floating stools. Has the patient had nausea, vomiting, or abdominal pain, which may indicate a GI disorder? Has he had excessive thirst, excessive urination, or heat intolerance, which may signal an endocrine disorder? Has he been experiencing other pain? If so, ask about the location of the pain and how long he has had it. Take a careful drug history, noting especially use of diet pills and laxatives.
Carefully check the patient's height and weight and ask about his previous weight. Take his vital signs and note his general appearance: Is he well nourished? Do his clothes fit? Is muscle wasting evident? Ask about exact weight changes (with approximate dates).
Examine the patient's skin for turgor and abnormal pigmentation, especially around the joints. Does he have pallor or jaundice? Examine his mouth, including the condition of his teeth or dentures. Look for signs of infection or irritation on the roof of the mouth and note hyperpigmentation of the buccal mucosa. Check the patient's eyes for exophthalmos and his neck for swelling; evaluate his lungs for adventitious sounds. Inspect his abdomen for signs of wasting, and palpate for masses, tenderness, and an enlarged liver.
Conventional laboratory and radiologic investigations such as complete blood count, serum albumin levels, urinalysis, chest X-ray, and upper GI series usually reveal the cause. Almost all physical causes are clinically evident during the initial evaluation. Cancer, GI disorders, and depression are the most common pathologic causes.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Gait, steppage [Equine gait, paretic gait, prancing gait, weak gait]:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Begin by asking the patient about the onset of the gait and recent changes in its character. Does a family member have a similar gait? Find out if the patient has had a traumatic injury to the buttocks, hips, legs, or knees. Ask about a history of chronic disorders that may be associated with polyneuropathy, such as diabetes mellitus, polyarteritis nodosa, and alcoholism. While you're taking the history, observe whether the patient crosses his legs while sitting because this may put pressure on the peroneal nerve.
Inspect and palpate the patient's calves and feet for muscle atrophy and wasting. Using a pin, test for sensory deficits along the entire length of both legs.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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