Rossi Gian Paolo
Department of Clinical & Experimental Medicine, Clinica Medica 4, University Hospital, University of Padova, Via Giustiniani 2, 35126 Padova, Italy.
Best Pract Res Clin Endocrinol Metab. 2006 Sep;20(3):385-400. doi: 10.1016/j.beem.2006.07.003.
Surgically correctable forms of primary aldosteronism are generally held to be less common than forms requiring medical therapy. However, with the availability of improved diagnostic techniques and the adoption of a systematic and thorough diagnostic work-up they can be identified more commonly than expected. Adrenal vein sampling (AVS) for measurement of cortisol and aldosterone has emerged as the 'gold standard' diagnostic test for identifying unilateral causes of primary aldosteronism that are amenable to surgical cure. Adrenalectomy can provide long-term normalisation of blood pressure and correction of primary aldosteronism in about 55% of patients with an aldosterone-producing adenoma and can markedly ameliorate blood pressure control in the rest. This chapter summarises the diagnostic work-up suggested for identifying these forms and examines the other diseases mimicking mineralocorticoid excess that enter into the differential diagnosis of surgically curable primary aldosteronism.
一般认为，可通过手术矫正的原发性醛固酮增多症形式比需要药物治疗的形式少见。然而，随着诊断技术的改进以及系统全面的诊断检查方法的采用，其被发现的频率比预期更高。用于测量皮质醇和醛固酮的肾上腺静脉采血（AVS）已成为识别可通过手术治愈的原发性醛固酮增多症单侧病因的“金标准”诊断测试。肾上腺切除术可使约55%的醛固酮分泌腺瘤患者血压长期恢复正常并纠正原发性醛固酮增多症，其余患者的血压控制也可得到显著改善。本章总结了为识别这些形式所建议的诊断检查方法，并探讨了其他模拟盐皮质激素过多的疾病，这些疾病也参与了可手术治愈的原发性醛固酮增多症的鉴别诊断。
