临床病例讨论——以双侧肾上腺腺瘤为特征的特发性醛固酮增多症

Idiopathic hyperaldosteronism characterized by bilateral adrenal adenoma

目的总结特殊的特发性醛固酮增多症的分型诊断及治疗经验。方法对我院收治的1例以双侧肾上腺腺瘤为特征的特发性醛固酮增多症患者的诊断治疗进行总结。结果本例46岁女性患者,因发作性血压升高2个月入院,经筛查、确诊、功能试验、多种影像学检查及双侧肾上腺静脉采血(adrenal venous sampling,AVS)分型,最终确诊为特发性醛固酮增多症。给予口服药物治疗,血压、血钾均控制理想。结论对于尚无典型高血压及低血钾表现的早期原醛症病例,及早正确筛查和分型诊断、正确治疗,可使患者最大临床获益。对于罕见的双侧肾上腺皮质腺瘤型醛固酮增多症,AVS检查对其治疗方案的选择起关键作用,AVS可作为影像学检查有疑问时分型诊断的金标准方法。

Objective To summarize the experience of diagnosis and treatment of special idiopathic hyperaldoste- ronism. Methods To summarize the experience of diagnosis and treatment of one patient with idiopathic hyperaldosteronism characterized by bilateral adrenal adenoma in our hospital. Results This was a 46-year-old woman presented with the blood pressure rose for 2 month. After differential diagnosis work up, diagnosis, functional tests, a variety of imaging studies and bilateral adrenal vein sampling （AVS） typing, she was finally diagnosed with idiopathic hyperaldosteronism. After given oral medication, blood pressure and potassium were ideally controlled and the condition was improved. Conclusion For patients without typical hypertension and hypokalemia performance, early identification and correct diagnosis of this complication is of great significance to improve the prognosis. For patients with rare bilateral adrenocortical adenoma type aldosteronism, AVS plays a key role in the choice of treatment regimen and can be used as a gold standard of differential diagnosis when imaging diagnosis is suspected