Idiopathic edema

Idiopathic edema is a syndrome of real or perceived excessive weight gain. This article reviews what is known about the possible causes, evaluation, a nd treatment. Although the cause is unknown but often thought to be due to secondary hyperaldosteronism, primary abnormalities of the hypothalamus, th yroid, dopaminergic release or renal dopaminergic metabolism, vascular base ment membrane, or capillary sphincter control could perhaps contribute in s ome patients. The diagnosis requires careful attention to possible abnormal ities of the river, heart, kidneys, gastrointestinal tract, thyroid, and pa ncreas. The history must include an evaluation for risks of bulimia and pur ging; diuretic and laxative screening should be performed. Specific records of daily weights, urinary outputs, and menstral cycle dates are useful. Tr eatment may include dietary counseling to provide weight control and a cons tant carbohydrate intake, treatments for depression, compression stockings, spironolactone, amiloride, angiotensin II inhibitors, or sympathomimetic a gents, depending on the severity and timing of the patient's symptoms. Unfo rtunately, idiopathic edema may be a multifactorial disorder that has not b een completely delineated. Further research into possible causative mechani sms is required before a more useful algorithm for evaluation and treatment is available. (C) 1999 by the National Kidney Foundation, Inc.