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1、原发性醛固酮增多症广东省人民医院冯颖青FormsofprimaryaldosteronismAldosterone-producingadenoma(APA)Bilateralidiopathichyperplasia(IHA)Primary(unilateral)adrenalhyperplasiaAldosterone-producingadrenocorticalcarcinomaFamilialhyperaldosteronism(FH)Glucocorticoid-remediablealdosteronism(FHtypeI)FHtypeII(APAorIHA)Numberof
2、diagnosedcasesofPAperyearTheJournalofClinicalEndocrinology&MetabolismVol.89,No.31045-1050PrevalenceofPAinhypertensivepatientsFirstauthor,yearScreeningtestConfirmatorytestNo.screenedNo.withPA(%)Mosso,2003PAC/PRAratioFludrocortisonesuppressiontest60937(6.1)Gordon,1994PAC/PRAratioDexamethasonesuppres
3、siontest19917(8.5)Abdelhamid,1996UrinaryaldosteroneandmetabolitesPosturalstimulationandsalineinfusion3900257(6.6)Rossi,1998LogisticdiscriminantanalysisNRmetabolites32019(5.9)Lim,1999PAC/PRAratioPAC(pmol/l)toPRA(ng/ml/h)ratio>75012518(14.4)Loh,2000PAC/PRAratioSalineinfusionsuppressiontest35016(4.6)
4、PercentageofPApatientswithhypokalemiaTheJournalofClinicalEndocrinology&MetabolismVol.89,No.31045-1050onlyasmallproportionofpatients(between9and37%,dependingonthecenter)werehypokalemic.A,From1957–1985,248patientswerediagnosedwithprimaryaldosteronismatMayoClinic;57%hadsurgicallyconfirmedAPA,and11%ha
5、dprobableAPA;theremainder(33%)hadprobableorconfirmedbilateralIHA.B,In1999,120patientswerediagnosedwithprimaryaldosteronismatMayoClinic;20%hadsurgicallyconfirmedAPA,and8%hadprobableAPA;theremainder(72%)hadprobableorconfirmedbilateralIHA.Firstauthor,yearDiagnostictestsNo.withPANo.withAPA(%)Grant,198
6、4PACandPRAbeforeandafterpostural10161(60.4)Weinberger,1993PACaftersodiumload,PRAafterlowsodiumdietorpostural6248(77.4)Blumenfeld,1994Aldosteroneexcretion,PACandPRAbeforeandafterposturalstimulation8252(63.4)Rossi,2001PACandPRAbeforeandafterdexamethasone10441(39.4)Magill,2001Aldosteroneexcretion,PAC
7、,PRA6215(24.2)Total(%)56.6bilateraladrenalhyperplasia(2/3ofcases)andaldosterone-producingadenoma(1/3ofcases)Schimenbach,BestPractResClinEndocrinolMetab.2006Sep;20(3):369-84肾上腺皮质病变Aldo↑储NA排K血容量↑PRA↓自主性低KBP↑机制临
