原发性醛固酮增多症(附507例报告)  

The diagnosis and treatment of primary aldosteronism(report of 507 cases)

作　　者：刘定益[1] 邵冰峰[2] 祝宇[1] 郑崇达[1] 

机构地区：[1]第二医科大学附属瑞金医院泌尿外科,上海200025 [2]南通肿瘤医院外科

出　　处：《中华泌尿外科杂志》2001年第7期413-416,共4页Chinese Journal of Urology

摘　　要：目的　提高原发性醛固酮增多症 (PA)的诊治水平。　方法　回顾性总结 5 0 7例PA的诊治资料。　结果　产生醛固酮的肾上腺腺瘤 (APA)患者血钾为 (2 .35± 0 .5 3)mmol/L ,血和 2 4h尿醛固酮分别为 (10 2 7.6 7± 5 31.84)pmol/L、(6 9.2 5± 43.77)mmol/L ,立位血浆醛固酮增加值为(- 17.17± 483.37) pmol/L。特发性醛固酮增多症 (IHA)血钾为 (2 .94± 0 .5 5 )mmol/L ,血和 2 4h尿醛固酮分别为 (781.14± 310 .2 4)pmol/L、(37.12± 9.99)mmol/L ,立位血浆醛固酮增加值为 (170 .36± 30 3.5 9) pmol/L。B超和CT对APA的诊断符合率分别为 83.9%和 93.1% ,IHA主要显示双侧肾上腺增大或小结节变化。肾上腺皮质癌 (APC)的特点是皮质醇和去氢异雄酮明显增高 ,且瘤体直径>5cm。　结论　APA血和尿醛固酮明显高于IHA ,APA血钾明显低于IHA ,体位试验、B超和CT能帮助确诊APA。单发APA合并肾上腺萎缩应行肾上腺部分切除 ,多发APA或合并肾上腺增生者应行患侧肾上腺全切。Objective To study the diagnosis and treatment of primary aldosteronism. Method 507 cases of primary aldosteronism were reviewed. Result Serum potassium was lower in aldosterone producing adenoma (APA) as compared to idiopathic hypersteronism (IHA) (2.35±0.53) mmol/L vs ( 2.94 ± 0.55 ) mmol/L.Aldosterone in serum and 24h urine were higher in APA than in IHA ( 1 027.67 ± 531.84 )pmol/L and (69.25±43.77) mmol/L vs (781.14±310.24)pmol/L and (37.12±9.99) mmol/L.The diagnosis rate on B ultrasonography was 83.9% and on CT 93.1%.The postural stimulation test was more sensitive in IHA and on imaging procedures both the adenals were increased in size or with small nodule.In aldosterone producing adrenocortical carcinoma (APC),there were pronounce increase of cortisol and dehydroisoandrosterone and the tumor size was usually greater than 5cm.APA and APC should be treated surgically but the prognosis was only favorable for APA not for APC.IHA should be treated medically. Conclusion Serum and urine aldosterone were significantly higher in APA and serum potassium lower than in IHA.Postural stimulation test,B ultrasonography and CT were helpful to the diagnosis of APA.In patients with a single APA especially complicated by adrenal atrophy,partial adnalectomy of the affectd side is indicated whereas total adrenalectomy of the affected side is mandatory if the APA is multiple or there is adrenal hyperplasia.

关 键 词：肾上腺肿瘤 醛固酮增多症 诊断 治疗 

分 类 号：R586.24[医药卫生—内分泌] R736.6[医药卫生—内科学]