临床病例讨论——原发性醛固酮增多症自发缓解

Spontaneous remission of idiopathic aldosteronism

目的对1例高血压伴低钾血症并明确诊断为原发性醛固酮增多症(以下简称原醛)且近期考虑病情自发缓解的病例进行分析,扩展原醛的临床诊断思路。方法对清华大学附属北京清华长庚医院1例确诊原醛、特发性醛固酮增多症可能性大的患者经治疗后自发缓解的病例进行分析并进行文献复习。结果本例患者病程中曾联合螺内酯及多种降压药物治疗,后自行停用螺内酯,逐渐减少降压药,最终口服硝苯地平控释片30 mg(1次/d)控制血压平稳;入院后复查血钾正常,肾上腺CT示左侧肾上腺增粗,卧立位醛固酮试验醛固酮与肾素比值(aldosterone to renin ratio, ARR)<30,考虑原醛自发缓解可能性大。近年来,国外陆续报道长时间应用盐皮质激素受体拮抗剂治疗的原醛患者可能会发生自发缓解,缓解率高达59%～76%。结论对明确诊断为原醛应用醛固酮受体拮抗剂治疗的患者,需定期评估患者病情,警惕自发缓解,及早给予患者最佳治疗方案。

Objective To investigate a case with primary aldosteronism who remised spontaneously.Methods The diagnosis and treatment of a patient who had been diagnosed with idiopathic aldosteronism experienced spontaneous remission were retrospectively analyzed and the related literatures were reviewed.Results During the course of the disease,the patient was treated with spironolactone and a variety of antihypertensive drugs.However,the patient stopped taking spironolactone and reduced antihypertensive drugs to monotherapy.BP of this patient was well controlled by oral administration of Nifedipine GITS 30 mg qd.At this time,the patient manifested normal serum potassium and normal aldosterone to renin ratio(ARR),suggesting spontaneous remission of the primary aldosteronism.Recently,multiple studies had reported that patients with primary aldosteronism who had been treated with mineralocorticoid receptor antagonists for a long time may experience spontaneous remission,and the remission rate may be as high as 59%to 76%.Conclusions It is necessary to reevaluate patients who are diagnosed as primary aldosteronism and treated with aldosterone receptor antagonist regularly,so as to discover spontaneous remission of primary aldosteronism as early as possible and change the treatment accordingly.