原发性醛固酮增多症的早期诊断(附18例病例分析)

A REPORT ON 18 CASES OF PRIMARY ALDOSTERONISM

目的：探讨原发性醛固酮增多症（ＰＡ）的早期诊断及各型间鉴别。方法：对我院１０ａ来收治的１８例ＰＡ患者的临床资料进行分析，其中肾上腺皮质腺瘤（ＡＰＡ）１１例、特发性醛固酮增多症（ＩＨＡ）５例、ＡＣＴＨ依赖型醛固酮增多症１例、混合型１例。结果：１８例均有高血压，１６例有低血钾。根据血、尿醛固酮升高，血浆肾素活性低，血醛固酮与血浆肾素活性比值（Ａ／ＰＲＡ）＞４００，安体舒通试验阳性等做出ＰＡ诊断。早期低钾表现明显，ＣＴ等影像检查呈单侧病变，直立位醛固酮不增高、应用外源性血管紧张素Ⅱ后反应缺乏主要见于ＡＰＡ患者，ＩＨＡ与之相反。结论：高血压患者伴自发性低钾或给予利尿剂后发生难纠正的低钾，均应警惕ＰＡ；

Objective:To study the diagnosis of primary aldosteronism(PA)and set up the criteria for a correct identification of PA.Methods:Eighteen hospitalized patients with PA were reviewed.Aldosterone producing adenoma(APA) and idiopathic hyperaldosteronism(IHA) were the most frequent forms.They consist of 61% and 28% respectively.Dexamethasone suppressible hyperaldosteronism(one case) has also been reported in the study.Results:All of the patients had hypertension,Sixteen patients had hypokalemia which was often found in the late period of PA.The diagnosis of PA can be confirmed easily by the demonstration of both plasma renin activity(PRA) suppression and aldosterone excess.Response to upright posture and angiotenson Ⅱ infusion was absent in most cases of APA.Conclusion:PA should be suspected in hypertensive patients who are spontaneous hypokalemia and who become hypokalemia almost concurrently with the administration of diuretics.An elevation of aldosterone PRA ratio more than 400 is a useful screening tool for the prediction of APA.