Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Aldosteronism

aldosteronism in العربية (المملكة العربية السعودية)

Related Terms

  • Conn's Disease
  • Conn's Syndrome
  • Familial Hyperaldosteronism Type I (FH - I)
  • Familial Hyperaldosteronism Type II (FH - II)
  • Glucocorticoid Remediable Aldosteronism (GRA)
  • Hyperaldosteronism
  • Idiopathic Aldosteronism
  • Idiopathic Hyperaldosteronism (IHA)
  • Primary Aldosteronism
  • Secondary Aldosteronism

Differential Diagnosis

  • Congenital adrenal hyperplasia
  • Deoxycorticosterone-producing tumors
  • Exogenous mineralocorticoid
  • High-dose glucocorticoid therapy
  • Liddle's syndrome
  • Malignant hypertension
  • Pheochromocytoma
  • Renin-secreting tumors
  • Renovascular hypertension

Specialists

  • Cardiologist, Cardiovascular Physician
  • Endocrinologist
  • General Surgeon
  • Nephrologist

Comorbid Conditions

Factors Influencing Duration

The length of disability may be influenced by the severity of symptoms, the stage of the tumor, the amount of damage to the organ systems caused by the disease prior to treatment, the type of treatment, and the individual's response to treatment.

Medical Codes

ICD-9-CM:
255.10 - Disorders of Adrenal Glands; Hyperaldosteronism, Unspecified; Aldosteronism NOS; Primary Aldosteronism NOS; Primary Aldosteronism, Unspecified
255.11 - Disorders of Adrenal Glands, Glucocorticoid-Remediable Aldosteronism; Familial Aldosteronism Type I
255.12 - Disorders of Adrenal Glands, Conns Syndrome
255.14 - Disorders of Adrenal Glands, Other Secondary Aldosteronism
255.3 - Disorders of Adrenal Glands, Other Corticoadrenal Overactivity; Acquired Benign Adrenal Androgenic Overactivity; Overproduction of ACTH

Overview

Aldosteronism is a disorder caused by excessive production of the hormone aldosterone, which is produced by the adrenal gland and is essential for normal kidney function. Oversecretion of aldosterone causes excess sodium to be retained while the kidneys excrete too much potassium.

The two types of aldosteronism are primary and secondary. Primary aldosteronism is caused by a tumor (usually noncancerous) of the adrenal gland (Conn's syndrome). Secondary aldosteronism occurs as a complication of other diseases, trauma, burns, or stress. Disorders such as heart failure and certain liver diseases (e.g., cirrhosis) can reduce blood flow through the kidney and lead to excessive aldosterone production. High blood pressure (hypertension) is a sign of aldosteronism and can prompt the adrenal gland to secrete excess aldosterone, creating a self-perpetuating cycle.

Individuals may carry a genetic predisposition for certain types of hyperaldosteronism. These inherited forms of primary hyperaldosteronism (familial hyperaldosteronism types I and II), account for only 1% of cases of primary aldosteronism and arise in childhood (Chrousos).

Incidence and Prevalence: It is estimated that aldosteronism affects 5% to 10% of individuals with hypertension.

Source: Medical Disability Advisor



Causation and Known Risk Factors

Primary hyperaldosteronism, the most common form of hyperaldosteronism, is an adult disease, with its peak incidence in those 40 to 60 years of age. It occurs most frequently in women between ages 30 and 50.

Source: Medical Disability Advisor



Diagnosis

History: Aldosteronism may not cause symptoms that prompt an individual to see a physician. When symptoms are present, they relate directly to the actions of aldosterone. A low potassium level can cause overproduction of urine (polyuria), which results in excessive thirst (polydipsia) due to fluid loss. Too much potassium excreted in the urine causes tiredness, weakness, muscle cramps, muscle spasms, and headaches. Some individuals may experience heart palpitations, often described as a fluttering feeling in the chest. In severe cases, periods of paralysis or mood changes may be reported.

Physical exam: Physical findings usually include hypertension. If the potassium level is severely low (hypokalemia), muscle weakness and decreased tendon reflexes can occur. In rare cases, high sodium levels may cause tissues to retain excessive amounts of fluid (edema).

Tests: Diagnosis is suggested by the combination of hypertension and a blood test that indicates a low potassium level. Renin and aldosterone are checked. Additional tests may include a 24-hour urine collection to measure aldosterone, free cortisol, and creatinine. If aldosterone levels are high, the diagnosis of aldosteronism can be confirmed by prescribing a medication (Spironolactone) that blocks the activity of this hormone and then checking if levels normalize. An MRI or CT of the adrenal glands may reveal a tumor.

Source: Medical Disability Advisor



Treatment

Treatment depends on the cause of the disease. Primary aldosteronism resulting from a tumor is often treated with surgical removal of the tumor. In some cases, part or all of one adrenal gland may be removed (adrenalectomy). Only in rare cases is it necessary to remove both adrenal glands. If the individual is unwilling or unable to undergo surgery, treatment then includes lifelong drug therapy, with radiation therapy as an option if the tumor is thought to be cancerous.

In cases in which surgery is not completely effective or in cases of secondary aldosteronism or bilateral hyperplasia, restriction of salt in the diet and use of medication (a potassium-sparing diuretic) may be necessary. Maintaining a healthy weight, regular exercise, and avoidance of tobacco may also be helpful. When aldosteronism is secondary to another disorder, treating the underlying disease may help resolve the aldosteronism.

Source: Medical Disability Advisor



Prognosis

The prognosis is generally excellent with early diagnosis and treatment. Surgical removal of an adrenal tumor or an adrenalectomy results in complete resolution of symptoms and return to normal blood pressure in about 70% of cases. However, blood pressure often does not return to normal immediately following surgery but rather changes gradually over 1 to 4 months. Adrenalectomy, when performed laparoscopically, is reported to have a lower operative morbidity and shorter hospital stay than the traditional open surgical technique.

If a tumor is responsible for the disease but cannot be removed, or if both adrenals are involved, the prognosis remains excellent with treatment. Medication and / or radiation therapy is effective for individuals with a tumor that cannot be treated surgically.

Maintaining a healthy, low-salt (sodium) diet, getting regular exercise, not smoking, and taking prescribed medications are also highly effective treatments for this condition. When aldosteronism is secondary to another disease, treatment of that disease is important for a good outcome. Overall, the majority of cases will experience a complete recovery from all symptoms if the diagnosis of aldosteronism is made early in the progression of the disease; if the cause of the condition is readily identified; and if the symptoms, the underlying disease, or both are treated promptly.

If aldosteronism is untreated or if treatment is delayed, irreversible damage to the heart and / or kidneys can occur. Depending on the extent of such damage, the prognosis may be less optimistic.

Source: Medical Disability Advisor



Complications

In about 30% of the cases, hypertension is a common complication that persists or returns in spite of surgery. Hypertension can lead to irreversible kidney and heart disease. Severely low levels of potassium can cause an irregular heartbeat (cardiac arrhythmia) that can be life-threatening. If treatment involves surgical removal of an adrenal tumor, some individuals may experience symptoms of low gland function, especially low blood pressure (hypotension), in the early postoperative period.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

In many cases, work restrictions and / or accommodations are not necessary. Those with severe hypertension and whose jobs require strenuous activity may require temporary reassignment to a less physically demanding position. Individuals treated with external beam radiation may require extended leave from work because it causes prolonged fatigue.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Was individual tired and weak? Did individual experience muscle cramps, spasms, or headaches?
  • Does individual have polyuria and polydipsia?
  • Did individual experience heart palpitations? Periods of paralysis? Mood changes?
  • Does individual have hypertension?
  • Were blood tests, including sodium and potassium levels, performed? Was a 24-hour urine test done? CT or MRI of the adrenals?
  • Was diagnosis confirmed by prescribing Spironolactone?
  • Were conditions with similar symptoms ruled out?

Regarding treatment:

  • Is individual's aldosteronism primary or secondary?
  • Did individual have surgery? Was it successful?
  • Did individual opt for drug therapy? Radiation therapy?
  • Has the underlying condition been treated?
  • If overweight or a smoker, has individual addressed these correctable factors?
  • Does individual exercise regularly?
  • Did individual seek medical attention during early stages of the condition?
  • Has individual been compliant with the treatment program?

Regarding prognosis:

  • Can individual's employer accommodate any necessary restrictions?
  • Does individual have any conditions that may affect the ability to recover?
  • Did any complications arise such as hypertension? Hypotension?
  • Has individual experienced any cardiac arrhythmias?

Source: Medical Disability Advisor



References

Cited

Chrousos, George P., and Antony Lafferty. "Hyperaldosteronism." eMedicine. Eds. Thomas A. Wilson, et al. 19 Feb. 2003. Medscape. 22 Oct. 2004 <http://emedicine.com/ped/topic1056.htm>.

Source: Medical Disability Advisor






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