原发性醛固酮增多症的诊断和治疗进展课件

《原发性醛固酮增多症的诊断和治疗进展课件》由会员上传分享，免费在线阅读，更多相关内容在教育资源-天天文库。

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确诊试验与分型诊断病例筛查Casedetection高发人群

2、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、⊕OOO1.0CaseDetection1.1WerecommendthecasedetectionofPAinpatientgroupswithrelativelyhighp

14、revalenceofPA(listedinTable1)(Fig.1).Wealsorecommendcasedetectionforallhypertensivefirst-degreerelativesofpatientswithPA.(1QOOO)1.2WerecommenduseoftheplasmaARRtodetectcasesofPAinthesepatientgroups(Fig.1).(1QQOO)2.0CaseConfirmation2.1Insteadofproceedingdirectlytosubtypeclassification,werecommendthatp

15、atientswithapositivealdosterone-reninratio(ARR)measurementundergotesting,byanyoffourconfirmatorytests,todefinitivelyconfirmorexcludethediagnosis(Fig.1).(1QQOO)3.0SubtypeClassification3.1WerecommendthatallpatientswithPAundergoanadrenalCTscanastheinitialstudyinsubtypetestingandtoexcludelargemassesthat

16、mayrepresentadrenocorticalcarcinoma(Fig.1).(1QQOO)3.2Werecommendthat,whensurgicaltreatmentispracticableanddesiredbythepatient,thedistinctionbetweenunilateralandbilateraladrenaldiseasebemadebyAVSbyanexperiencedradiologist(Fig.1).(1QQQO)3.3InpatientswithonsetofconfirmedPAearlierthanat20yrofageandintho

17、sewhohaveafamilyhistoryofPAorofstrokesatyoungage,wesuggestgenetictestingforGRA(Fig.1).(2QOOO)4.0Treatment4.1WerecommendthatunilaterallaparoscopicadrenalectomybeofferedtopatientswithdocumentedunilateralPA(i.e.APAorUAH)(Fig.1).(1QQOO)Ifapatientisunableorunwillingtoundergosurgery,werecommendmedicaltrea

18、tmentwithanMRantagonist(Fig.1).(1QQOO)4.2InpatientswithPAduetobilateraladrenaldisease,werecommendmedicaltreatmentwithanMRantagonist(1QQOO);wesuggestspironolactoneastheprimaryagentwitheplerenoneasanalt