Primary Aldosteronism: 13 Cases Analysis

原發性醛固酮症：13病例分析

廖文魁(Wen-Kuei Liao) ； 林石化(Shih-Hua Lin) ； 吳篤安(Du-An Wu) ； 傅茂祖(Martin M-T Fuh)

《Journal of Medical Sciences》 17卷2期 (1996/10) Pp. 123-130

摘要

本院自1986年6月至1992年6月共有十三例住院的原發性醛固酮症患者，臨床症狀主要為：肌肉無力12例，頭痛11例，頭暈6例，多尿6例，暈厥2例。常見的臨床表徵高血壓（平均病史3年）13例，無力癱瘓3例，一例有腦梗塞及心臟擴大。12位患者血鉀濃度低於3.0mEq/L（2.5±0.3mEq/L），9位患者血鈉濃度超過145mEq/L（146.9±3.3mEq/L），24小時尿中排鉀量超過30mEq者有12位（44.3±16.2mEq/day）。血漿醛固酮濃度皆升高（765.7±277.9pg/ml），且血漿腎素之活性皆降。血漿醛固酮濃度與血漿腎素活性比值都超過30。5位患者接受生理食鹽水輸液試驗，結果都顯示血漿醛固酮濃度無法抑制（超過85pg/ml）。13位患者做腹部電腦斷層檢查，6位做姿態試驗，7位做腎上腺靜脈抽血檢查。診斷有9位是腎上腺皮質腺瘤，4位為腎仁腺皮質增生。9位患者接受單側腎上腺切除術，病理報告顯示有8位確實是皮質腺瘤，另一位是結節增生。8位腎上腺皮質腺瘤患者手術後三個月內，高血壓及低血鉀皆痊癒。4位腎上腺皮質增生患者接受藥物治療，除一位患者做姿態試驗血漿醛固酮反應降低，如同腺瘤反應情形，而被假想是原發性結節增生，其餘3位反應良好。我們認為腹部電腦斷層檢查可提供一確定腺瘤的可靠方法（診斷正確性92.3%）。此外姿態試驗也是一種有效、簡單的方法（診斷正確性83.3%），用於診斷手術可治癒的原發性結節增生，腎上腺脈靜脈抽血檢查可用於診斷腫瘤的定位（本組患者只做到腎脈靜脈抽血檢查，診斷正確性71.4%），以及當電腦斷層和姿態試驗無法明確區分單側或雙側疾病時。

關鍵字

血漿醛固酮濃度 ； 血漿腎素活性 ； 腎上腺皮質腺瘤 ； 腎上腺皮質增生 ； 原發性腎上腺皮質結節增生

並列摘要

Thirteen cases of primary aldosteronism from June, 1986 to June, 1992 were studied. The presenting symptoms were mainly muscle weakness (12/13), headache (11/13), dizziness (8/13), polyuria (6/13), and syncope (2/13). The most frequent sign in all cases was hypertension (mean 3 years), flaccid paralysis in three cases, and recent CVA, cardiomegaly in one case. Twelve cases had serum potassium levels less than 3.0 mEq/L (2.5±0.3 mEq/L). Nine cases had serum sodium levels more than 145 mEq/L (146.9±3.3 mEq/L). Daily urinary K excretion more than 30 mEq were found in 12 cases (44.3±16.2 mEq/day). All cases had increased PAC (765.7±277.9 pg/ml) and decreased PRA. The ratio of PAC to PRA were greater than 30 in all cases. Five cases received saline infusion test, and all revealed non-suppressible PAC (more than 85 pg/ml). Further investigations included abdominal CT scan (13/13), posture test (6/13), and adrenal vein sampling (7/13). Nine cases of aldosterone-producing adenoma, and 4 cases of idiopathic hyperaldosteronism were diagnosed. All of 9 cases received unilateral adrenalectomy and 8 cases were proved as cortical adenoma and one case as nodular hyperplasia by the pathologic findings. The hypertension and hypokalemia were cured within 3 months in all APA cases receiving unilateral adrenalectomy. Four cases of idiopathic hyperaldosteronism received spironolactone treatment and responded well except one case of presumptive primary adrenal hyperplasia with paradoxical fall of plasma aldosterone concentration by posture test and diuretics test like a form of an adenoma. We own that abdominal CT scan (13/13) can provide a reliable method for identification of tumor (diagnostic accuracy 92.3%). Besides, the simple posture test (6/13) is a very useful adjunctive method (diagnostic accuracy 83.3%), and may diagnose primary adrenal hyperplasia which can be cured by surgery. Adrenal vein sampling (7/13), which is renal vein sampling actually in our cases with diagnostic accuracy 71.4%, can be performed for the localization of tumor and the identification of unilateral or bilateral disease when the distinction was inclusive by the CT scan and posture test.

並列關鍵字

plasma aldosterone concentration(PAC) ； plasma renin activity(PRA) ； aldosterone-producing adenoma(APA) ； idiopathic hyperaldosteronism(IHA) ； primary adrenal hyperplasia(PAH)