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Symptoms and Signs – Differential Diagnosis of Hypertension
Vascular: coarctation of aorta, renal artery stenosis
Renal disease: chronic glomerulonephritis, chronic pyelonephritis, cystic kidney disease, renal carcinoma
Pre-eclampsia
Essential (idiopathic)
Endocrine disease: Cushing's syndrome, Conn's disease, phaeochromocytomas, acromegaly, primary hyperparathyroidism
Drugs: oestrogen-containing OCPs, steroids
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Symptoms and Signs – Differential Diagnosis of Hyperprolactinaemia
Physiological: pregnancy, lactation, stress
Prolactinoma, rarely ectopic prolactin (lung, kidney tumours)
Reduced Dopamine transport to the anterior pituitary: pituitary tumour compressing
pituitary stalk (pseudoprolactinoma affect)
Drugs:
Depletion of central dopamine stores: reserpine, methyldopa
Dopamine receptor blockers: (chlorpromazine, haloperidol, sulpiride,
metoclopramide, domperidone)
Increased TRH secretion stimulates prolactin release (1° hypothyroidism)
Oestrogens: HRT/OCP, PCOS (oestrogen stimulates lactotrophs)
Chest wall injury (stimulation of the reflex pathway normally activated by
suckling in lactating women)
Others: liver failure, l dopamine synthesis/release from the hypothalamus
(tumour, inflammation, arteriovenous malformations)·
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Symptoms and Signs – Differential Diagnosis of Hyperpigmentation
Radiation
Post-inflammatory, e.g. after erythroderma
Photosensitive rashes See Photodistributed rash
Others: chronic renal failure, chronic·wasting (TB, carcinoma), disseminated malignant melanomatosis
Liver disease: haemochromatosis, primary biliary cirrhosis
Endocrine: Addison's disease, Nelson's syndrome, ectopic ACTH, pregnancy
Drugs: amiodarone, busulfan, chlorpromazine, phenothiazines



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Symptoms and Signs – Differential Diagnosis of Hyperkalemia
ACE inhibitors
Addison's disease
Amiloride and other potassium-sparing diuretics
Pseudohyperkalaemia: haemolysis, leucocytosis, thrombocytosis
Released from cells: acidosis, rhabdomyolysis, suxamethonium
Renal failure
Renal tubular acidosis type 4


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Symptoms and Signs – Differential Diagnosis of Hyperkeratosis (palmoplantar)
2° syphilis
Congenital (tylosis, an autosomal dominant condition)
Friction (e.g. walking barefoot)
Keratoderma blenorrhagica (Reiter's syndrome)
Malignancy: gastric adenocarcinoma, bronchial carcinoma
Psoriasis
Toxidmetabolic: drug reaction, arsenic, vitamin A deficiency



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Symptoms and Signs – Differential Diagnosis of Hyperparathyroidism
1° hyperparathyroidism
Parathyroid adenoma or hyperplasia (may be associated with MEN syndromes)
and rarely carcinoma
2° hyperparathyroidism
l Calcium (e.g. due to vitamin D deficiency or resistance or chronic renal failure)
3° hyperparathyroidism
Autonomous parathyroid hyperplasia secondary to long-standing 2°
Hyperparathyroidism


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Symptoms and Signs – Differential Diagnosis of Hypernatraemia
Dehydration:
Reduced Fluid intake: elderly, confused or unconscious
Increased Fluid loss GI: diarrhoea vomiting
Renal: diabetes insipidus, osmotic diuresis (e.g. hyperglycaemia,
hypercalcaemia)
Skin: excessive sweating
Hyperosmolar non-ketotic coma
Excess Na+ administration (e.g. sodium bicarbonate)
Excess mineralocortcoids: hyperaldosteronism



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Symptoms and Signs – Differential Diagnosis of Hyperphosphataemia
Renal failure
Hypo & Pseudohypoparathyroidism (PTH: Phosphate Trashing Hormone!)
Rhabdomyolysis
Tumour lysis syndrome
Acromegaly
Excessive phosphate intake/administration
Vitamin D intoxication



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