Stowasser M
Hypertension Unit, University Department of Medicine, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane 4102, Australia.
Curr Hypertens Rep. 2001 Jun;3(3):230-9. doi: 10.1007/s11906-001-0045-3.
Wider application of the aldosterone/plasma renin activity ratio among hypertensives has facilitated the detection of primary aldosteronism at earlier stages of evolution (with most patients normokalemic), and found prevalence rates far greater than those previously reported. Reliable detection of patients with PAL requires that 1) the diagnosis is considered in all hypertensives; 2) blood samples are collected under standardized conditions of diet, posture, and time of day; 3) medications known to alter the ratio are avoided or their effects taken into account; 4) aldosterone and plasma renin activity are measured using consistently accurate assay techniques; and 5) reliable methods (such as fludrocortisone suppression testing) are used to confirm primary aldosteronism. Adrenal venous sampling is the only dependable way to differentiate aldosterone-producing adenoma from bilateral adrenal hyperplasia. As has occurred in familial hyperaldosteronism type I, the elucidation of genetic mutations causing other forms of primary aldosteronism should further facilitate detection of this potentially curable or specifically treatable variety of hypertension.
醛固酮/血浆肾素活性比值在高血压患者中的更广泛应用有助于在原发性醛固酮增多症演变的早期阶段（大多数患者血钾正常）进行检测，且发现患病率远高于先前报道。可靠检测原发性醛固酮增多症患者需要：1）所有高血压患者均考虑该诊断；2）在饮食、体位和一天中的时间等标准化条件下采集血样；3）避免使用已知会改变该比值的药物或考虑其影响；4）使用始终准确的检测技术测量醛固酮和血浆肾素活性；5）使用可靠方法（如氟氢可的松抑制试验）来确诊原发性醛固酮增多症。肾上腺静脉采血是区分醛固酮瘤与双侧肾上腺增生的唯一可靠方法。正如在I型家族性醛固酮增多症中所发生的那样，对导致其他形式原发性醛固酮增多症的基因突变的阐明应进一步有助于检测这种潜在可治愈或可特异性治疗的高血压类型。
