Severe Hypokalemia and Rhabdomyolysis Associated with Conn's Syndrome: Clinical Approach to Aldosterone-Related Kaliuresis

背景：嚴重低血鉀合併橫紋肌溶解症，通常帶來需要迅速及正確地做出鑑別診斷的挑戰。方法：我們使用剛排出尿液中鉀離子及肌酸酐的比例，來鑑別低血鉀的致病原因。結果：個案本身已有5年的高血壓病史，初始血液生化值呈現明顯的低血鉀（1.8mmol/L）及代謝性鹼血症，同時尿液中鉀離子排出是低的，而個案本身並無濫用利尿劑之情形；經由積極的鉀離子補充後，個案仍呈現持續性的低血鉀（3.0mmol/L）。隨後高醛固酮血症被證實，左側腎上腺內一直徑2.4公分的腫塊亦被發現；經過腹腔鏡手術作左側腎上腺切除後，個案恢復的情況良好，並且無需後續其他藥物治療。討論：測算剛排出尿液中鉀離子及肌酸酐的比例，作為低血鉀鑑別診斷的工具是有效的方法，然而，在嚴重低血鉀的情況下，醛固酮造成的尿鉀排泄作用可能被侷限。

關鍵字

低血鉀；橫紋肌溶解症；高醛固酮血症；康氏症

並列摘要

Background: Profound hypokalemia, accompanied by rhabdomyolysis, often makes rapid and accurate differential diagnosis challenging. Methods: We used the potassium-to-creatinine ratio in freshly voided urine to differentiate the etiology of hypokalemia. Results: A 27-year-old man with a 5-year history of hypertension presented with an initial biochemistry indicating marked hypokalemia (1.8 mmol/L) and metabolic alkalosis with low urinary potassium excretion. The patient did not have a history of abusing alcohol or diuretics. Persistent hypokalemia (3.0 mmol/L) continued despite aggressive potassium supplementation. Hyperaldosteronism was confirmed, and computed tomography revealed a 2.4-cmdiameter mass over the left adrenal gland. After undergoing laparoscopic left adrenalectomy, the patient's condition improved without further medication. Discussion: It is feasible to use the potassium-to-creatinine ratio in freshly voided urine for the differential diagnosis of hypokalemia. However, this case highlights that the initial kaliuretic effect of aldosterone may be restricted in severe hypokalemia.

並列關鍵字

hypokalemia ； rhabdomyolysis ； hyperaldosteronism ； Conn's syndrome

國際替代計量

Severe Hypokalemia and Rhabdomyolysis Associated with Conn's Syndrome: Clinical Approach to Aldosterone-Related Kaliuresis

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