Chapter VA6 - Idiopathic Edema

Abstract

Idiopathic edema is a poorly understood disorder that affects primarily women and causes salt retention and edema in the absence of cardiac, renal, hepatic, or thyroid disease. Despite many studies of the various factors controlling the renal handling of sodium and water, the disease remains idiopathic. It may represent a heterogenous collection of edematous disorders, since a variety of abnormalities have been discovered in different subsets of patients. A uniform explanation for its pathophysiology has been lacking and the causes have been postulated to be hormonal, metabolic, or psychologic. The disorder provides a dramatic demonstration of the problem that occurs when fine control of extracellular volume is lost. The usual complaint is troublesome edema of the legs, hands, and periorbital region, with a sensation of swelling and distention in the abdomen. The edema may recur intermittently or can be persistent as discussed in this chapter. Although many women gain weight during the luteal phase of the menstrual cycle, premenstrual edema has not been a common complaint in patients with idiopathic edema. A high familial incidence of Type II diabetes has been reported in several series, and abnormal glucose tolerance has been noted in many patients; however, fewer than 50% of patients are overweight. There are some similarities between idiopathic edema and anorexia nervosa in that both are primarily noted in women and both can be associated with disturbances of body image. Due to the poorly understood nature of the disorder and its many postulated mechanisms, no single treatment for idiopathic edema exists.