Adrenal Cortical Adenoma Initially Presenting with Acute Aortic Dissection, Hypokalemic Paralysis, and Marked Hypertension

腎上腺皮質腺瘤以嚴重高血壓，主動脈剝離，及下肢癱瘓為起始表現

邱俊仁(Chiung-Zuan Chiu) ； 徐國基(Kou-Gi Shyu)

《中華民國急救加護醫學會雜誌》 21卷1期 (2010/03) Pp. 41-46

https://doi.org/10.30018/JECCM.201003.0007

摘要

腎上腺皮質腺瘤(Adrenal adenoma)為一罕見之續發性高血壓原因之一。臨床上常以高血壓及低血鉀為表現。我們報告一38歲女性以嚴重背痛之症狀求診。同時發現有嚴重高血壓，Stanford B型主動脈剝離，即下肢癱瘓之表現。經電腦斷層掃描結果有左側腎上腺腫瘤合併低renin，高aldosterone，及低血鉀。因上述表現而懷疑為腎上腺皮質腺瘤合併嚴重高血壓致主動脈剝離及低血鉀性癱瘓。下肢癱瘓於矯正高血鉀後改善。經腹腔鏡腎上腺腫瘤切除後，血壓及血鉀值不經藥物即正常。而病理報告亦證實為腎上腺皮質腺瘤。

關鍵字

腎上腺皮質腺瘤 ； 續發性高血壓 ； 低血鉀 ； 主動脈剝離 ； 下肢癱瘓

並列摘要

Adrenal cortical adenoma is a rare cause of secondary hypertension and may present with elevated blood pressure and hypokalemia. We reported a 38-year-old female with adrenal adenoma presenting with a rare initial manifestation of severe back pain. Acute aortic dissection, marked hypertension and lower leg paralysis were noted simultaneously. Stanford type B aortic dissection and left adrenal tumor were noted by computed tomography angiography. Hypokalemia, high serum aldosterone and low renin level make the clinical suspicion of adrenal adenoma. Blood pressure was under optimal treatment after intensive medical treatment and lower leg paralysis was resolved after correction of hypokalemia. The patient underwent laparoscopic adrenectomy later and the pathology report proved to be adrenal adenoma. Blood pressure and serum potassium level returned to normal after adrenectomy and the patient was uneventful in the following days without any medication.

並列關鍵字

adrenal cortical adenoma ； secondary hypertension ； hypokalemia ； aortic dissection ； lower leg paralysis