临床病例讨论——以低钙血症为首发症状的原发性醛固酮增多症

目的 对1例以低钙抽搐为首发症状并最终诊断为原发性醛固酮增多症病例进行分析及文献学习,扩展原发性醛固酮增多症的临床诊断思路.方法 对我院l例“反复发作全身抽搐4年”以低钙血症查因,最终诊断为原发性醛固酮增多症的病例进行诊断、鉴别诊断和治疗.对醛固酮和甲状旁腺激素(parathyroid hormone,PTH)的相互作用进行文献复习.结果 患者以低钙血症、高PTH、全身抽搐为主要表现,住院期间发现高血压伴低钾血症.实验室检查提示低肾素,高醛固酮水平,肾上腺CT提示右侧肾上腺腺瘤,诊断为原发性醛同酮增多症.手术切除腺瘤.术后血钾、血钙、肾素和醛固酮水平恢复正常,PTH和血压水平明显下降.结论 低钙血症可能是原发性醛固酮增多症的临床症状之一,当患者同时存在低钙血症和难治性高血压时,应考虑到原发性醛固酮增多症的可能性,并进行筛查,以免漏诊.醛固酮与PTH可以相互作用,并导致器官的损害,通过切除醛固酮瘤或抗醛固酮治疗,可以同时减低醛固酮和PTH水平,减少器官的损伤.

Primary aldosteronism first presented with hypocalcemia and hyperspasmia

Objective To analyzed a case with first presentation of hypocalcemia and hyperspasmia,which final diagnosed as primary aldosteronism.Methods A case of complaints of recurrent systemic hyperspasmia for 4 years was reported,and the cause and treatment of hypocalcemia was investigated,which final diagnosed as primary aldosteronism.Literature were reviewed of the relationship between aldosterone and parathyroid hormone(PTH).Results The main complaint of the patient was hypocalcemia,high level of PTH and hyperspasmia.At the same time,it was found that the patient had hypertension with hypokalemia,hyporeninemic and hyperaldosteronism.Abdominal CT showed right mass of adrenal cortex.The patient was diagnosed as primary aldosteronism.After operation,the level of K+,Ca2+,renin,aldosterone became normal,and PTH,BP decreased.Conclusion Hypocalcemia is one of the clinical symptoms of primary aldosteronism.When patients suffer hypocalcemia,increased PTH and refractory hypertension,the primary aldosteronism should be taken into consideration to avoid missed diagnosis.Aldosterone and PTH can interact with each other and cause further damage to organs.The surgical excision or anti-aldosterone treatment can reduce the organ damage caused by decreasing PTH and aldosterone levels.