以与血压升高无关的发作性头晕为表现的不典型原发性醛固酮增多症5例分析  

Atypical primary aldosteronism with paroxysmal dizziness but without elevation of blood pressure:an analysis of five cases

作　　者：张海玲[1] 方玲 陶沂[1] 毕晓莹[1] ZHANG Hai-ling;FANG Ling;TAO Yi;BI Xiao-ying(Department of Neurology,Changhai Hospital,Naval Medical University(Second Military Medical University),Shanghai 200433,China)

机构地区：[1]海军军医大学(第二军医大学)长海医院神经内科,上海200433

出　　处：《第二军医大学学报》2020年第11期1279-1283,共5页Academic Journal of Second Military Medical University

摘　　要：目的总结以与血压升高无关的发作性头晕为表现的不典型原发性醛固酮增多症(PA)的神经系统表现、诊治及预后。方法和结果对2016年至2019年我科确诊的5例以发作性头晕为表现的不典型PA患者的临床资料进行回顾性分析。5例患者中男1例、女4例,年龄50~95岁,均以反复头晕起病,病程20 d^1年,发作频次为每月0.5次至每天1~2次不等,每次持续数秒至30 min,可伴头痛、视物旋转、恶心、耳鸣、乏力、多汗、心悸等,面色可发红或自觉头面部发热感,体位变化或活动时明显,发作间歇期无明显不适。2例患者有高血压病史,3例患者入院后24 h动态血压监测发现血压波动。5例患者入院血钾均在正常参考值范围内,2例头晕发作时测血钾降低。肾上腺CT增强检查仅1例提示左侧肾上腺增生,余4例未见明显异常。5例患者血浆醛固酮与肾素活性比值均升高,结合肾上腺CT结果诊断为PA。5例患者均予螺内酯治疗,临床定期随访,头晕明显好转。结论以反复发作性头晕为主要表现且头晕发作与血压升高无关的不典型PA少见,临床医师需提高认识。要仔细了解高血压病史并进行醛固酮测定,以避免误诊和漏诊。低钾血症灵敏度和特异度较低,已不能作为筛查PA的良好指标。Objective To summarize the neurologic manifestations,diagnosis,treatment and prognosis of atypical primary aldosteronism(PA)with paroxysmal dizziness which is not associated with elevated blood pressure.Methods and Results The clinical data of five patients diagnosed as atypical PA with paroxysmal dizziness but without elevation of blood pressure were retrospectively analyzed.Among the five patients,one was male and four were females,aged 50-95 years,with onset of paroxysmal dizziness.The disease duration was 20 d to 1 year,with the frequency ranged from 0.5 times per month to 1-2 times a day,lasting for a few seconds to 30 min every time,with concomitant symptoms including headache,vertigo,nausea,tinnitus,fatigue,hyperidrosis,palpitation,etc.The complexion may turn red or the head and face may feel febrile consciously,especially during the posture changes or the activity,and there was no obvious discomfort during interictal period.Two patients had a history of hypertension,and three patients had blood pressure fluctuations after 24 h ambulatory blood pressure monitoring.The serum potassium of the five patients was in the normal range on admission,and it was decreased in two patients with dizziness onset.Adrenal contrast-enhanced computed tomography showed left adrenal hyperplasia in one case and no significant abnormalities in the other four cases.The aldosterone renin ratio(ARR)increased,and PA was diagnosed by combining the result of adrenal computed tomography.All the five patients were treated with spironolactone,and their dizziness was significantly improved after regular clinical follow-up.Conclusion Atypical PA with paroxysmal dizziness but without elevated blood pressure is rare,and further study is needed to better understand the disease.To avoid misdiagnosis and missed diagnosis,the history of hypertension should be inquired,and the aldosterone should be valued.Hypokalemia could not be used as a good indicator for PA screening due to low sensitivity and specificity.

关 键 词：发作性头晕 原发性醛固酮增多症 醛固酮 高血压 钾 

分 类 号：R586.24[医药卫生—内分泌]