一位39歲男性以反覆性低血鉀為表現

低血鉀有許多造成的原因，若無正確診斷可能造成呼吸衰竭至生命危險。本案例是一位39歲男性病患，曾在六年前因頑固的高血壓、肢體無力及低血鉀入院，被診斷低血鉀週期性痲痺，並接受鉀離子補充治療。此次在住院一天前因全身無力、嚴重低血鉀導致肌肉癱瘓併呼吸衰竭，經檢驗報告發現代謝性鹼血症、血液高醛固酮、低血漿腎素活性，及腹部電腦斷層確診左側醛固酮分泌腺瘤。病患經手術治療後高血壓獲得改善及低血鉀恢復正常。因此，當我們遇到病患有頑固的高血壓、代謝性鹼血症、不易矯正的低血鉀，原發性皮質醛酮症就必須列入考慮。

關鍵字

低血鉀；低血鉀週期性麻痺症；原發性皮質醛酮症； Conn症候群

並列摘要

Hypokalemia has many causes and can lead to life-threating complications. We reported a 39-year-old male patient, who was diagnosed with hypokalemic periodic paralysis 6 years ago due to intractable hypertension, limb weakness, and hypokalemia. He received potassium supplement therapy thereafter. The day prior to this hospitalization, he had generalized weakness and severe hypokalemia, which resulted in muscle paralysis complicated with respiratory failure. Laboratory study revealed high serum aldosterone, low renin activity, and metabolic alkalosis. The computed tomography showed left adrenal aldosterone-producing adenoma. His hypertension and hypokalemia were resolved after undergoing lapascopic left adrenectomy. Therefore, when a patient has intractable hypertension, metabolic alkalosis, and uncorrectable hypokalemia, the possibility of primary aldosteronism should be taken into consideration.

並列關鍵字

hypokalemia ； hypokalemic periodic paralysis ； primary aldosteronism ； Conn syndrome

參考文獻

Abad-Cardiel, M., Álvarez-Álvarez, B., Luque-Fernandez, L., Fernández, C., Fernández-Cruz, A., & Martell-Claros, N. (2013). Hypertension caused by primary hyperaldoste-ronism: increased heart damage and cardiovascular risk. Revista Española de Cardiología (English Edition), 66(1), 47-52. doi:10.1016/j.recesp.2012.07.025

Carey, R. M. (2016). Diagnosing and Managing Primary Aldoste-ronism in Hypertensive Patients: a Case-Based Approach. Current cardiology reports, 18(10), 97. doi:10.1007/s11886-016-0774-1

Chen, W., Li, F., He, C., Zhu, Y., & Tan, W. (2014). Elevated prevalence of abnormal glucose metabolism in patients with primary aldosteronism: a meta-analysis. Irish journal of medical science, 183(2), 283-291. doi:10.1007/s11845-013-1007-x

Cheng, C. J., Kuo, E., & Huang, C. L. (2013). Extracellular Potassium Homeostasis: Insights from Hypokalemic Pe-riodic Paralysis. Seminars in Nephrology, 33(3), 237-247. doi:10.1016/j.semnephrol.2013.04.004.

Funder, J. W., Carey, R. M., Mantero, F., Murad, M. H., Rein-cke, M., Shibata, H., ... Young, Jr., W. F. (2016). The man-agement of primary aldosteronism: case detection, diag-nosis, and treatment: an endocrine society clinical practice guideline. The Journal of Clinical Endocrinology & Me-tabolism, 101(5), 1889-1916. doi:https://doi.org/10.1210/jc.2015-4061

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一位39歲男性以反覆性低血鉀為表現

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