原发性醛固酮增多症46例报告

目的:探讨原发性醛固酮增多症（PA）的诊断和治疗方法。方法:对1988年～2001年间收治的PA46例进行分析。所有患者均行血醛固酮测定、安体舒通试验及B超、CT检查。40例行肾上腺肿瘤切除术,6例行肿瘤切除术及同侧肾上腺部分切除术。结果:肾上腺皮质腺瘤45例,肾上腺皮质增生1例。46例血钾均低于正常,42例血醛固酮增高,46例安体舒通试验均阳性,B超、CT定位检查,其准确率分别为84.8％、95.6％。46例患者血钾均恢复正常。44例肾上腺腺瘤治愈,1例腺瘤及1例肾上腺皮质增生仍需药物控制血压。结论:安体舒通试验、血醛固酮测定是PA的主要定性诊断方法,血醛固酮体位试验和影像学检查有助于肾上腺皮质腺瘤和增生的鉴别;PA的定位主要依靠B超、CT检查。外科手术是治疗PA的重要方法。

Diagnosis and treatment of primary aldosteronism (report of 46 cases)

Objective:To improve the diagnosis and treatment of primary aldosteronism (PA). Methods: From 1988 to 2001,46 PA patients treated by surgery were retrospectively analyzed. All patients were done serum aldosterone assay, spironolactone test and were examed B ultrasonography and CT. 40 cases were enucleated adrenal adenomas, 6 cases were cured by adrenalectomy. Results: Of which, 45 cases were adrenal adenomas and 1 adrenocortical hyperplasia. Hypokalemia was found in 46 patient and plasma aldosterone level elevated in 42 cases examined. Spironoalctone test was positive in 46 patients. The diagnostic accuracy of B ultrasonograhy and CT was 84. 8% and 95. 6%, respectively. The results revealed that serum potassium level of 46 cases increased to normal range, that 44 cases of adrenal adenomas were cured and 2 cases are still needed to control blood pressure by drug after operation. Conclusion: Spironolactone test and serum aldosterone assay are the main methods of PA qualitative diagnosis. Location test and ultrasongraphy exam would be help to differentiate adrenal adenomas and adrenocortical hyperplasia. The Location diagnosis of PA mainly depended on B ultrasonograhy and CT, which diagnostic accuracy was 84. 8% and 95. 6% , respectively. Operation is the important method for PA treatment.