関: hypoaldosteronism、type IV renal tubular acidosis

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/01/19 15:04:33」(JST)

wiki en

In medicine (endocrinology), hypoaldosteronism refers to decreased levels of the hormone aldosterone.

Isolated hypoaldosteronism is the condition of having lowered aldosterone without corresponding changes in cortisol.^[1] (The two hormones are both produced by the adrenals.)

Causes

There are several causes for this condition, including primary adrenal insufficiency, congenital adrenal hyperplasia, and medications (certain diuretics, NSAIDs, and ACE inhibitors).

Aldosterone deficiency-Primary (rare)

Primary adrenal insufficiency
Congenital adrenal hyperplasia (21 and 11β but not 17)
Aldosterone synthase deficiency

Hyporeninemic hypoaldosteronism (due to decreased angiotensin 2 production as well as intra-adrenal dysfunction)^[2]

Renal dysfunction-most commonly diabetic nephropathy
ACE inhibitors
NSAIDs
Cyclosporine

Treatment

Aldosterone deficiency should be treated with a mineralocorticoid (such as fludrocortisone), as well as possibly a glucocorticoid for cortisol deficiency, if present.
Hyporeninemic hypoaldosteronism is amenable to fludrocortisone treatment,^[2] but the accompanying hypertension and edema can prove a problem in these patients, so often a diuretic (such as the thiazide diuretic, bendrofluazide,or a loop diuretic, such as furosemide) is used to control the hyperkalemia.^[3]

Effects

This condition may result in hyperkalemia, when it is sometimes termed 'type 4 renal tubular acidosis' even though it doesn't actually cause acidosis. It can also cause urinary sodium wasting, leading to volume depletion and hypotension.

Na+ is lost in the urine. K+ is retained, and the plasma K+ rises.^{[citation needed]}

When adrenal insufficiency develops rapidly, the amount of Na+ lost from the extracellular fluid exceeds the amount excreted in the urine, indicating that Na+ also must be entering cells. When the posterior pituitary is intact, salt loss exceeds water loss, and the plasma Na+ falls. However, the plasma volume also is reduced, resulting in hypotension, circulatory insufficiency, and, eventually, fatal shock. These changes can be prevented to a degree by increasing the dietary NaCl intake. Rats survive indefinitely on extra salt alone, but in dogs and most humans, the amount of supplementary salt needed is so large that it is almost impossible to prevent eventual collapse and death unless mineralocorticoid treatment is also instituted.^{[citation needed]}

References

^ Becker, Kenneth L. (2001). Principles and practice of endocrinology and metabolism. Lippincott Williams & Wilkins. pp. 785–. ISBN 978-0-7817-1750-2. Retrieved 15 July 2011.
^ ^a ^b DeFronzo RA (1980). "Hyperkalemia and hyporeninemic hypoaldosteronism". Kidney Int. 17 (1): 118–34. doi:10.1038/ki.1980.14. PMID 6990088.
^ Sebastian A, Schambelan M, Sutton JM (1984). "Amelioration of hyperchloremic acidosis with furosemide therapy in patients with chronic renal insufficiency and type 4 renal tubular acidosis". Am. J. Nephrol. 4 (5): 287–300. doi:10.1159/000166827. PMID 6524600.

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. 低アルドステロン症（4型RTA）の病因、診断、および治療 etiology diagnosis and treatment of hypoaldosteronism type 4 rta
2. 副腎疾患におけるレニン-アンギオテンシン-アルドステロン系の評価 assays of the renin angiotensin aldosterone system in adrenal disease
3. 成人における高カリウム血症の原因および評価 causes and evaluation of hyperkalemia in adults
4. HIV感染患者における下垂体および副腎の機能不全 pituitary and adrenal gland dysfunction in hiv infected patients
5. 糖尿病症例解説15：2型糖尿病および再発性高カリウム血症を有する74歳女性 interactive diabetes case 15 a 74 year old woman with type 2 diabetes and recurrent hyperkalemia

English Journal

A case of hyporeninemic hypoaldosteronism in the dog.

Kreissler JJ, Langston CE.SourceMiami Veterinary Specialists, Miami, FL 33143, USA. jkreissler@mvshospital.com
Journal of veterinary internal medicine / American College of Veterinary Internal Medicine.J Vet Intern Med.2011 Jul-Aug;25(4):944-8. doi: 10.1111/j.1939-1676.2011.0741.x. Epub 2011 Jun 22.
PMID 21696443

Clinical approach to renal tubular acidosis in adult patients.

Reddy P.SourceDepartment of Medicine, University of Florida College of Medicine, Jacksonville, FL 32209, USA. pramod.reddy@jax.ufl.edu
International journal of clinical practice.Int J Clin Pract.2011 Mar;65(3):350-60. doi: 10.1111/j.1742-1241.2009.02311.x.
Renal tubular acidosis (RTA) is a group of disorders observed in patients with normal anion gap metabolic acidosis. There are three major forms of RTA: A proximal (type II) RTA and two types of distal RTAs (type I and type IV). Proximal (type II) RTA originates from the inability to reabsorb bicarbo
PMID 21314872

Japanese Journal

4型腎尿細管性アシドーシス

石橋正太,竹林晃三,麻生好正 [他]
内分泌・糖尿病・代謝内科 32(1), 116-122, 2011-01
NAID 40018735848

Isolated Adrenocorticotropin Deficiency Presenting with Impaired Renin-Angiotensin-Aldosterone System and Suppressed Parathyroid Hormone-Vitamin D Axis

SAITO Takatoshi,TOJO Katsuyoshi,YAMAMOTO Hiroyasu,HOSOYA Tatsuo,TAJIMA Naoko
Internal medicine 41(7), 561-565, 2002-07-01
… She showed severe hyponatremia due to secondary adrenocortical insufficiency, which was deteriorated by hypoaldosteronism. …
NAID 10009278057

Long-Term Follow-Up of Mitomycin C Nephropathy

MOTOO Yoshiharu,SAWABU Norio,IKEDA Kenzo,TAKEMORI Yasuhiro,OHTA Hideki,OKAI Takashi,YOKOYAMA Hitoshi
Internal Medicine 33(3), 180-184, 1994
… Hyporeninemic hypoaldosteronism was transiently seen in case 2. …
NAID 130000771070

「低レニン性低アルドステロン症」

Hypoaldosteronism
	Aldosterone
Classification and external resources
Specialty	Endocrinology
ICD-10	E27.4
DiseasesDB	20960
MeSH	D006994
	[edit on Wikidata]

　　[★]

英: hyporeninemic hypoaldosteronism
同: 低レニン血症性低アルドステロン症、低レニン低アルドステロン症
関: アルドステロン、アルドステロン症、高レニン性低アルドステロン症

「低レニン血症性低アルドステロン症」

　　[★]

英: hyporeninemic hypoaldosteronism
関: 低アルドステロン症、低レニン性低アルドステロン症、4型尿細管性アシドーシス

「type IV renal tubular acidosis」

　　[★]

尿細管性アシドーシスIV型、4型尿細管性アシドーシス

関: hypoaldosteronism、hyporeninemic hypoaldosteronism

「hypoaldosteronism」

　　[★] 低アルドステロン症

[Becker2001-1] Becker, Kenneth L. (2001). Principles and practice of endocrinology and metabolism. Lippincott Williams & Wilkins. pp. 785–. ISBN 978-0-7817-1750-2. Retrieved 15 July 2011.

[hypoaldosteronism-2] DeFronzo RA (1980). "Hyperkalemia and hyporeninemic hypoaldosteronism". Kidney Int. 17 (1): 118–34. doi:10.1038/ki.1980.14. PMID 6990088.

[3] Sebastian A, Schambelan M, Sutton JM (1984). "Amelioration of hyperchloremic acidosis with furosemide therapy in patients with chronic renal insufficiency and type 4 renal tubular acidosis". Am. J. Nephrol. 4 (5): 287–300. doi:10.1159/000166827. PMID 6524600.

リンク元	「低レニン性低アルドステロン症」「低レニン血症性低アルドステロン症」「type IV renal tubular acidosis」
関連記事	「hypoaldosteronism」

匿名

検索

案内

案内

hyporeninemic hypoaldosteronism