Differential Diagnosis for Patient with Dyspepsia, Polyuria, Hypernatraemia, Hypertension, and Hypokalaemia

• Single Most Likely Diagnosis
  • Primary Hyperaldosteronism (Conn’s Syndrome or Bilateral Adrenal Hyperplasia): This condition is characterized by the excess production of aldosterone, leading to hypertension, hypokalaemia, and metabolic alkalosis. The symptoms presented, including dyspepsia (possibly due to hypokalaemia-induced muscle weakness), polyuria (due to hypokalaemia affecting renal concentrating ability), hypernatraemia, hypertension, and hypokalaemia, are consistent with primary hyperaldosteronism. The presence of hypertension and hypokalaemia are particularly suggestive of this diagnosis.
• Other Likely Diagnoses
  • Secondary Hyperaldosteronism: This condition involves the excessive production of aldosterone in response to an extra-adrenal stimulus, such as renal artery stenosis or heart failure. While it shares many symptoms with primary hyperaldosteronism, the underlying cause and some clinical features may differ.
  • Cushing’s Syndrome: Caused by excess cortisol, this condition can lead to hypertension, hypokalaemia, and sometimes glucose intolerance or dyspepsia. However, other symptoms like weight gain, moon face, and buffalo hump are more characteristic.
• Do Not Miss Diagnoses
  • Pheochromocytoma: Although less likely, this tumor of the adrenal gland can cause episodic hypertension, and less commonly, hypokalaemia. It's crucial to consider due to its potential for severe, life-threatening hypertension.
  • Renal Artery Stenosis: This condition can lead to secondary hyperaldosteronism and presents with hypertension and potentially hypokalaemia. It's a critical diagnosis to consider due to its implications for renal function and blood pressure control.
• Rare Diagnoses
  • Liddle’s Syndrome: A rare genetic disorder characterized by excessive sodium absorption and potassium secretion in the kidneys, leading to hypertension and hypokalaemia. It's much less common than primary hyperaldosteronism but can present similarly.
  • Apparent Mineralocorticoid Excess: Another rare condition where the symptoms mimic those of hyperaldosteronism due to an abnormality in cortisol metabolism, leading to an apparent excess of mineralocorticoid activity.