原发性醛固酮增多症术前鉴别诊断分析

目的提高对原发性醛固酮增多症(PA)中腺瘤(APA)和特发性醛固酮增多症(IHA)患者的诊断水平。方法对近5年临床确诊的52例PA患者的生化检查、体位试验、影像学检查与术后病理结果进行分析。结果APA患者血钾低于IHA组,尿钾、尿PH高于IHA组;体位试验结果:17例APA患者中立位血醛固酮较卧位升高11例,下降的6例,35例IHA患者立位血醛固酮均较基础升高;影像学检查:APA患者B超、CT、MR I诊断符合率分别为50%、90%和91.6%。IHA患者符合率则为68%、93.75%和90.48%。结论APA患者部分生化异常程度较IHA患者明显;体位试验在APA和IHA中有部分重叠,立位血醛固酮升高者者不能排除APA,而血醛固酮下降者可确诊APA;CT与MR I诊断符合率基本相似。

Predictive value of preoperative tests in discriminating aldosterone - producing adrenal adenoma from idiopathic hvperplasia

Objective To improve the diagnosis of adenoma(APA) and idiopathic hyperaldosteronism(IHA) in primary aldosteronism(PA).Metholds From 1998 to 2003,52 PA patients underwent beside chemistry-test,posture-test and imaging.Results Compared with the patients with IHA,the patients with APA had lower serum potassium,higher urine potassium and urine PH.It was found that the plasma aldosterone after posture-test was decreased in 6 patients of 17 patients with APA,and increased in the others.It was increased in all 35 IHA patients.To all the APA patients,the diagnosis on B-ultrasonography was 50%,while on CT 90% and on MRI91.6%.While to IHA patients,the diagnosis on B-ultrasonography,CT and MRI was 68%.,93.75% and 90.48% espectively.Conclusion The abnormalties of laboratory in patients with APA are more evidence than those of IHA.The results of posture test are overlapped in a considerable amount of APA and IHA.Now those with elevation of serum aldosterone after posture-test and not exclude the APA,while those with decreasing level can be confirmed as APA.The diagnosis on CT and MRI was almost same.