单侧肾上腺结节增生性原发性醛固酮增多症的临床特点和随访结果分析

目的比较不同类型原发性醛固酮增多症的病例资料,探讨单侧肾上腺结节性增生的原发性醛固酮患者的临床特点,术前诊断方法和手术疗效。方法收集明确诊断为原发性醛固酮增多症的患者145例,分为醛固酮瘤组、单侧肾上腺结节性增生组和双侧增生组,分析各组术前的临床资料、生化与激素水平、高血压靶器官损害情况,比较各组术后血压、血钾和血醛固酮水平,所有患者术前均行肾上腺CT检查,其中62例患者行肾上腺插管采血检查。结果145例患者中,单侧结节增生14例,醛固酮瘤76例,双侧增生55例,单侧结节增生的发生率为9．7％（14／145）;性别构成、发病年龄、高血压时间、血压以及高血压靶器官的损害程度与其他两组相似;血钾、血、尿醛固酮值介于醛固酮瘤和双侧增生之间;单侧肾上腺结节增生CT检查有50％（7／14）和诊断相符,肾上腺静脉插管检查准确性为85．7％（12／14）;单侧肾上腺结节增生患者术后血钾,血醛固酮均恢复正常,50％（7／14）血压恢复正常,50％（7／14）血压明显改善。结论单侧肾上腺结节增生通过手术可以治愈,临床和肾上腺CT检查有一定的提示作用,明确诊断需要肾上腺静脉插管采血检查。

Clinical characteristics and surgery outcomes of unilateral nodular adrenal hyperplasia in primary aldosteronism: study of 145 cases

Objective To investigate the clinical characteristics, differential diagnosis, and surgery outcome of unilateral nodular adrenal hyperplasia (UNAH). Methods The clinical data of 145 patients with primary aldosteronism, 67 males and 78 females, aged 37.9 (19~60), including 78 cases of aldosterone-producing adenoma (APA), 14 cases of UNAH, and 55 cases of idiopathic bilateral adrenal hyperplasia (BAH), were collected. Radioimmunoassay was used to examine the blood and urine aldosterone and plasma rennin activity. Automatic biochemical apparatus was used to examine the blood and urine electrolytes, renal functions, and urine microalbumin. Twelve-lead elctrocardiography, echocardiography, and plain scanning of enhanced CT scanning of the bilateral adrenals were conducted. Adrenal venous sampling (AVS) was conducted in 62 patients to collect blood samples from vena cava and bilateral suprarenal veins to detect the levels of aldosterone and cortisol. All UNAH patients and 3 BAH patients underwent unilateral adrenalectomy and thee APA patients underwent unilateral adrenalectomy or adenoma resection. Then the patients were followed up for 39.2 months. Results The incidence of UNAH is 9.7% in the primary aldosteronism patients. There were no significant differences in age, gender, duration of hypertension, blood pressure (SBP, DBP), and indexes indicating damages in target organs of hypertension (left ventricular hypertrophy rate, blood creatinine, urine microalbumin, etc) among these three groups. The level of serum potassium of the APA group was significantly lower than that of the BAH group (P<0.01), and the levels of plasma and urine aldosterone of the APA group were significantly higher than those of the BAH group (P<0.05 and P<0.01). The serum potassium of the UNAH group was higher than that of the APA group and lower than that of the BAH group, and the levels of plasma and urine aldosterone of the UNAH group were both higher than those of the APA group and lower than those of the BAH group, however all not significantly (all P>0.05).The coincidence rate of CT was 50% (7/14) in the UNAH group. The accuracy of AVS for diagnosis of UNAH was 85.7% (12/14). After operation, the serum potassium and plasma aldosterone concentrations returned normal in all the UNAH patients. Blood pressure returned o normal in 50% (7/14) of the UNAH patients, and was improved in the other 50% (7/14) patients. Conclusion UNAH can be cured by adrenal surgery. The diagnostic values of clinical examination and adrenal CT are limited. AVS is essential in diagnosing UNAH patients.