原發性皮質醛酮過多症：一個誤診為原發性高血壓的病例

Primary Hyperaldosteronism: A Misdiagnosis as "Essential Hypertension"

湯文津(Wen-Chin Tang) ； 鍾嫈嫈(Jin-Jin Tjung) ； 張奐光(Huang-Kuang Chang) ； 陳碧芳(Be-Fong Chen)

《台灣家庭醫學雜誌》 14卷3期 (2004/09) Pp. 150-157

https://doi.org/10.7023/TJFM.200409.0150

摘要

原發性皮質醛酮過多症是造成續發性高血壓中重要的原因之一，若早期發現，尤其是腎上腺皮脂腺瘤，可用手術加以治療，並根治高血壓。本篇就一位原先診斷為原發性高血壓的病患，多年後因為低血鉀引起週期性肌肉無力，經腹部電腦層及核磁共振掃描發現右腎上方有一腫瘤，才進而發現為單側腎上腺皮脂腺瘤的案例。病人經手術切除腫瘤後，血壓回復正常，術後定期追蹤檢查並無再發肌肉無力現象。本文的目的是希望藉此病例以及文獻的回顧，提醒基層醫師的眾多高血壓的病患中要隨時記得先排除次發性病因的存在，早期發現，早期治療，以減少併發症。

並列摘要

Primary hyperaldosteronism is an important cause of secondary hypertension. When adrenal cortical adenoma is the pathologic culprit, it can be treated by surgical removal to cure the hypertension. This case study presents a patient who, after being misdiagnosed as essential hypertension for some years, exhibited several instances of periodic muscle weakness because of hypokalemia. Further imaging studies with abdominal computed tomography and magnetic resonance imaging revealed a right suprarenal mass. After surgical removal of the tumor, her blood pressure returned to normal and there was no recurrence of muscle weakness. Pathologic findings showed a 2.7×2×2 cm(superscript 3) adrenal cortical adenoma. In reviewing the clinical presentation, pathophysicologic findings and management of primary hyperaldosteronism, we want to remind primary care doctors of this rare but important possibility while providing care for their hypertensive patients. With early diagnosis and treatment, complications and morbidity can be reduced.

並列關鍵字

secondary hypertension ； primary aldosteronism ； episodic muscle weakness