原发性醛固酮增多症延误诊断的临床分析

Causes of delaying diagnosis of primary hyperaldosteronism with adrenal adenoma and strategy therefore

目的 分析原发性醛固酮增多症肾上腺腺瘤延误诊治的原因，探讨应对策略。方法 回顾性分析北京协和医院近10年经手术证实的原发性醛固酮增多症肾上腺腺瘤267例的临床资料，相关参数资料进行统计学处理。结果 267例均有高血压病史3～40年。初诊医院中78．3％为二级医院，21．7％为三级医院。95．9％初诊为原发性高血压病而未做相关肾上腺影像学及内分泌检查导致诊断延误。所有患者均有低钾血症表现2～9年，其中87．3％复诊查血生化诊断为低钾血症，余病例未作血钾检测。初诊至确诊间期（92±64）个月。超声检查疑似肾上腺区肿瘤151例，增强薄层CT扫描发现肾上腺肿瘤267例。结论 青壮年的高血压患者应排除继发因素，需做原醛症的相关内分泌检查。血浆醛固酮浓度／肾素比值是筛查有效手段。临床医师应重视低钾血症原因并提高分析能力。定位手段首选肾上腺区薄层CT平描加增强。

Objective To analyze the causes of delaying diagnosis of primary hyperaldosteronism with adrenal adenoma and discuss corrective strategies. Methods The clinical data of 267 patients of primary hyperaldosteronism with adrenal adenoma confirmed by operation 1995-2005 were analyzed. Results Confirmed diagnosis was made after a duration of （92±64） months （3-40 years） after the first visit. 78.3% of the hospitals where the patients with hypertension made their first visits were grade Ⅱ hospitals, and 21.3% of them were grade Ⅲ hospitals. 95.9% of the patients were diagnosed as with primary hypertension at the first visit without receiving relevant imaging examination of adrenal and endocrine examination. 87.3% of the patients with extremity weakness numbness of finger tips were diagnosed as with hypokalemia and more than 10% of them failed to receive examination of blood potassium. Adrenal adenoma was discovered by computed tomography with thin coat screening in 267 patients and by ultrasonography in 151 patients. Conclusion Primary hyperaldosteronism should be considered and screened in all young patients with hypertension. Plasma aldosterone/rennin ratio is an effective mark in screening. The first choice diagnostic means for primary hyperaldosteronism should be computed tomography with screening by coat 2-4 mm thin.