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1、CaseDetection,Diagnosis,andTreatmentofPatientswithPrimaryAldosteronism: AnEndocrineSocietyClinicalPracticeGuideline原发性醛固酮增多症的病例检测、诊断和治疗：内分泌学会临床实践指南------JClinEndocrinolMetab，2008，93（9）：3266－3281．几个问题PA发病率及临床意义：<1%→>10%更高的心脑血管疾病发病率及死亡率；特异性治疗可改善预后PA中低钾血症的发生率ARR测定方法及截点确定PA
2、确诊试验与分型诊断病例筛查Casedetection高发人群1
3、⊕⊕OOPA一级亲属合并高血压者1
4、⊕OOO筛查方法ARR1
5、⊕⊕OO确诊试验Caseconfirmation4个确诊试验之一即可1
6、⊕⊕OO亚型分类及定位Subtypeclassification肾上腺CT1
7、⊕⊕OO肾上腺静脉采血1
8、⊕⊕⊕O基因测定1
9、⊕⊕OO治疗Treatment单侧腹腔镜1
10、⊕⊕OO双侧或不能手术用MR拮抗剂1
11、⊕⊕OO螺内酯首选Eplerenone备选2
12、⊕OOOGRA小剂量糖皮质激素1
13、⊕OOO1.0CaseDetection1.1Werec
14、ommendthecasedetectionofPAinpatientgroupswithrelativelyhighprevalenceofPA(listedinTable1)(Fig.1).2.0CaseConfirmation2.1Insteadofproceedingdirectlytosubtypeclassification,werecommendthatpatientswithapositivealdosterone-reninratio(ARR)measurementundergotesting,byanyoffour
15、confirmatorytests,todefinitivelyconfirmorexcludethediagnosis(Fig.1).(1QQOO)3.0SubtypeClassification3.1WerecommendthatallpatientswithPAundergoanadrenalCTscanastheinitialstudyinsubtypetestingandtoexcludelargemassesthatmayrepresentadrenocorticalcarcinoma(Fig.1).(1QQOO)3.2W
16、erecommendthat,whensurgicaltreatmentispracticableanddesiredbythepatient,thedistinctionbetweenunilateralandbilateraladrenaldiseasebemadebyAVSbyanexperiencedradiologist(Fig.1).(1QQQO)3.3InpatientswithonsetofconfirmedPAearlierthanat20yrofageandinthosewhohaveafamilyhistoryo
17、fPAorofstrokesatyoungage,wesuggestgenetictestingforGRA(Fig.1).(2QOOO)4.0Treatment4.1WerecommendthatunilaterallaparoscopicadrenalectomybeofferedtopatientswithdocumentedunilateralPA(i.e.APAorUAH)(Fig.1).(1QQOO)Ifapatientisunableorunwillingtoundergosurgery,werecommendmedic
18、altreatmentwithanMRantagonist(Fig.1).(1QQOO)4.2InpatientswithPAduetobilateraladrenaldisease,werecommendmedicaltreatmentwithanMRantagonist(1QQOO);wesuggestspironolactoneastheprimaryagentwitheplerenoneasanalternative(Fig.1).(2QOOO)4.3InpatientswithGRA,werecommendtheuseoft
19、helowestdoseofglucocorticoidthatcannormalizebloodpressureandpotassiumlevelsratherthanfirst-linetreatmentwithan
