There may be signs of acute intoxication, withdrawal, or cravings with cocaine/sympathomimetics use.
History of treatment with or ingestion of nonsteroidal anti-inflammatory drugs, oral contraceptive pills, sympathomimetics, herbal medications (e.g., black cohosh, capsicum, ma huang), licorice, immunosuppressants (cyclosporin, tacrolimus), erythropoietin, higher-dose corticosteroids, or chemotherapeutic anti-endothelial growth factor agents (bevacizumab) and tyrosine kinase inhibitors (e.g., sunitinib, sorafenib).
Drug toxicology screen may detect an illicit substance.
Hypokalemia if excessive licorice.
There may be pruritus, edema, or change in urine output.
High serum creatinine.
Chronic anemia may be seen.
Renal ultrasound may identify sclerotic or polycystic kidneys.
Typically younger patients with difficult-to-control hypertension or older patients at risk of atherosclerotic disease.
Renal artery bruits may be present.
Renal duplex ultrasound or magnetic resonance angiogram of renal arteries confirms diagnosis.
Differential blood pressure in upper and lower extremities. Absent femoral pulses.
CT, angiogram, or MRI confirms diagnosis.
Typically obese patients with daytime somnolence, snoring, or choking during sleep.
Polysomnography shows nocturnal oxygen desaturation.
Few signs and symptoms other than mild metabolic alkalosis, relative hypernatremia, potassium depletion, and elevated fasting glucose.
Plasma aldosterone high.
Plasma renin low.
Failure to suppress aldosterone with salt loading.
Dry skin, cold intolerance, weight gain, sluggishness, and goiter.
Thyroid-stimulating hormone elevated in primary hypothyroidism.
Heat intolerance, weight loss, hyperphagia, palpitations.
Thyroid-stimulating hormone suppressed and levels of free thyroid hormones elevated.
There are often no differentiating symptoms; however, renal colic, abdominal pain, or bone fracture may occur.
Hypercalcemia, with elevated or inappropriately normal serum PTH.
Classic symptoms and signs include weight gain, moon face, dorsocervical fat pad, abdominal striae, and easy bruisability.
Abnormal dexamethasone suppression, 24-hour urine free cortisol, and/or late-night salivary cortisol.
Paroxysms of hypertension, flushing, and headache.
24-hour urine screen shows elevated vanillylmandelic acid, metanephrines, and/or catecholamines.
Acral (hand/foot/jaw) enlargement.
Elevated insulin-like growth factor-1. Elevated serum growth hormone level, not suppressed by glucose load.
Signs/symptoms of systemic lupus erythematosus, rheumatoid arthritis, sclerodactly, or history of vasculitis.
Elevated erythrocyte sedimentation rate, abnormal complement levels, positive anti-DNA, antiribonucleoprotein, anti-Smith antibodies, positive rheumatoid factor.
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