原发性醛固酮增多症术后持续性重度高钾血症1例  

Persistent and serious hyperkalemia after surgery of primary aldosteronism:A case report

作　　者：王薇[1] 蔡林[2] 高莹[1] 郭晓蕙[1] 张俊清[1] WANG Wei;CAI Lin;GAO Ying;GUO Xiao-hui;ZHANG Jun-qing(Department of Endocrinology,Peking University First Hospital,Beijing 100034,China;Department of Urology,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院内分泌科,北京100034 [2]北京大学第一医院泌尿外科,北京100034

出　　处：《北京大学学报（医学版）》2022年第2期376-380,共5页Journal of Peking University:Health Sciences

摘　　要：高钾血症是原发性醛固酮增多症术后可能发生的并发症之一,但原发性醛固酮增多症术后的高钾血症在临床实践中并不常见,而持续性重度高钾血症更加罕见,临床工作中该并发症也未得到足够的重视。本研究报告1例原发性醛固酮增多症患者肾上腺腺瘤术后出现持续性严重高钾血症的病例,并进行长期随访。患者因原发性醛固酮增多症行经腹腔镜左肾上腺肿物切除术,术后病理学诊断示肾上腺皮质腺瘤。术后1个月随访发现高钾血症,血钾最高7.0 mmol/L,患者自觉皮肤瘙痒、恶心、心悸。复查血浆醛固酮水平由术前35.69 ng/dL降至术后2.12 ng/dL,24 h尿钾排出明显减少。醛固酮激素的明显下降导致尿钾排出减少可能是引起患者术后高钾血症的原因。予聚磺苯乙烯钠散、呋塞米、复方甘草酸苷降钾治疗,至术后随访14个月患者仍需服用降钾药物来维持血钾水平。用“原发性醛固酮增多症”“高钾血症”“手术治疗”检索2009至2019年发表在PubMed及万方数据库的相关文献,发现原发性醛固酮增多症术后高钾血症的发生率约为6%~29%,大多数以轻中度、一过性高血钾为主,19%~33%的高血钾患者为持续性,影响原发性醛固酮增多症术后高钾的危险因素主要包括肾功能减退、年龄大和高血压病程长等。本研究通过该病例结合文献复习,总结原发性醛固酮增多症手术治疗后出现高钾血症患者的临床特点,以提高临床医生对该严重并发症的认识,尤其对有高危因素的患者,术后更需密切监测血钾。Hyperkalemia was one of the complications after primary aldosteronism surgery.Hyperkalemia after primary aldosteronism surgery was uncommon in clinical practice,especially persistent and serious hyperkalemia was rare.This complication was not attached great importance in clinical work.A case about persistent and serious hyperkalemia after primary aldosteronism adrenal adenoma surgery was reported and the patient was followed-up for fourteen months in this study.This patient had a laparoscopic adrenalectomy due to primary aldosteronism.Hyperkalemia was detected one month after surgery of this patient,the highest level of plasma potassium was 7.0 mmol/L.The patient felt skin itchy,nausea,palpitation.Plasma aldosterone concentration fell to 2.12 ng/dL post-operation from 35.69 ng/dL pre-operation,zona glomerulosa insufficiency was confirmed by hormonal tests in this patient after surgery.And levels of 24 hours urinary potassium excretion declined.Decrease of aldosterone levels after surgery might be the cause of hyperkalemia.Hyperkalemia lasted for 14 months after surgery and kalemia-lowering drugs were needed.A systemic search with“primary aldosteronism”,“hyperkalemia”,“surgical treatment”was performed in PubMed and Wanfang Database for articles published between January 2009 and December 2019.Literature review indicated that the incidence of hyperkalemia after primary aldosteronism surgery was 6%to 29%.Most of them was mild to moderator hyperkalemia(plasma potassium 5.5 to 6.0 mmol/L)and transient.19%to 33%in hyperkalemia patients was persistent hyperkalemia.Previous studies in the levels of plasma potassium reached the level as high as 7 mmol/L in our case were rare.Whether hypoaldosteronemia was the cause of hyperkalemia was not consistent in the published studies.Risk factors of hyperkalemia after primary aldosteronism surgery included kidney dysfunction,old age,long duration of hypertention.This paper aimed to improve doctors’aweareness of hyperkalemia complication after primary aldosteronism sur

关 键 词：原发性醛固酮增多症 手术治疗 高钾血症 

分 类 号：R589.4[医药卫生—内分泌]