原发性醛固酮增多症合并横纹肌溶解2例并文献复习

Primary aldosteronism associated with rhabdomyolysis:a report of 2 cases and review of the literature

目的:探讨原发性醛固酮增多症(简称原醛症)伴横纹肌溶解的临床特点以指导对该病的诊治。方法:对我院诊断的2例原醛症伴横纹肌溶解及文献中检索到的19例该病患者进行分析。结果:所有患者均有高血压病史,主要表现为乏力、肌痛、低钾血症及高肌酶谱,少部分患者有肌红蛋白尿、肾损伤及转氨酶异常。经大量补液、碱化尿液等对症治疗,横纹肌溶解得以纠正,而经过手术或药物治疗后血钾、血压恢复正常。结论:对于原醛症的高危人群应尽早进行筛查,可避免病情进展而导致横纹肌溶解等严重并发症的发生,而对于确诊为原醛症的患者,血钾低于2.0 mmol/L的醛固酮腺瘤应警惕横纹肌溶解的发生。已出现横纹肌溶解的原醛症患者,应在积极对症治疗的基础上根治原发病。

Objective：To investigate the clinical features of primary aldosteronism associate with rhabdomyolysis and to guide the diag- nosis and treatment of the disease. Methods ：The presentation and symptoms of the two patients in our hospital were described and the relevant literature was reviewed. A thorough literature search disclosed 19 further cases of rhabdomyolysis due to undiagnosed pri- mary aldosteronism. Results ： All patients had a history of hypertension, including fatigue, myalgia, hypokalemia and high muscle en- zymes,and there were a small number of patients who had abnormal myoglobinuria,acute renal failure and abnormal liver enzyme. Rhabdomyolysis was cured by a large amount of fluid and urine alkalization. All patients were restored to normal blood pressure and normal serum potassium levels after drug or adrenal surgical interventions. Conclusion：For the high risk population of primary aldos- teronism,early screening should be conducted to prevent disease progression and serious complications such as rhabdomyolysis,and for patients with dignosed primary aldosteronism whose serum potassium is lower than 2.0 mmol/L,rhabdomyolysis should be alerted. Primary aldosteronism patients with rhabdomyolysis should actively receive symptomatic treatment and cure the primary disease.