利用兩側腎上腺靜脈採血術診斷原發性腎上腺皮質醛酮過多症合併單側腎上腺腺瘤

一位56歲男性主訴下肢抽搐、無力、無法工作，時好時壞，且合併有十幾年的高血壓，輾轉各地求診，雖經抽血檢查發現有皮質醛酮分泌過多同時血鉀過低等現象，同時亦經電腦斷層檢查兩側腎上腺，沒有決定性之診斷。後經本院施行兩側性腎上腺靜脈採血術，測定右側腎上腺靜脈血中皮質醛酮值435 pg/ml，左側高達25690 pg/ml，同時血中腎素值偏低0.65 ng/ml/hr而診斷為單側腎上腺皮質腺瘤，手術時成功地取出腺瘤，術後病人得到完全的康復。兩側性腎上腺靜脈採血術（bilateral adrenal vein plasma sampling）為一經改良且診斷率高的方法，一般經過訓練的放射科醫師均能有效地利用，此例為本院首次施行且成功之病例報告。

關鍵字

腎上腺腺瘤；腎上腺皮質醛酮過多症；腎上腺靜脈採血術

並列摘要

Since Conn described the first patient with hypertention, neuromuscular disability and renal potassium wasting, the unilateral adrenal adenoma has been operable and curable. The difficulty of definite diagnosis makes the disease impossible to be differentiated from bilateral adrenal hyperplasia which is the disease with low successful rate by surgical treatment.Recently, we demonstrated a case of primary hyperaldosteronism with unilateral adrenal adenoma, and, patient had clinical menifestations of hypertention, hypokalemia, muscle wasting, polydypsia and polyuria. He underwent bilateral adrenal vein sampling by transfemoral catheterization, and was found to have marked and significant difference of plasma level of aldosterone concentration: Lt/Rt=25690 pg/ml: 435 pg/ml. The diagnosis was then confirmed by adrenal C-T scan. An adrenocortical adenoma with 1.5 cm^3 in size was found and removed in operation. Patient got complete improvement including blood pressure, symptoms and signs one month after surgery. The method is therefore useful if unilateral adrenal adenoma is suspected clinically even if adrenal C-T scan discloses negative finding. So in spite of it's invasion, it is available in clinically and makes possible to cure more patients who suffer from hypertention.

並列關鍵字

Unilateral adrenal adenoma ； Adrenal vein plasma sampling

國際替代計量

利用兩側腎上腺靜脈採血術診斷原發性腎上腺皮質醛酮過多症合併單側腎上腺腺瘤

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