Mazza A, Zamboni S, Armigliato M, Zennaro R, Cuppini S, Rempelou P, Rubello D, Pessina A C
Unit of Internal Medicine, Rovigo General Hospital, Rovigo, Italy.
Minerva Endocrinol. 2008 Jun;33(2):127-46. Epub 2008 Feb 15.
Endocrine arterial hypertension (EAH) a condition in which hormone excess results in clinically significant hypertension is a rare cause of hypertension. However in the last years its prevalence has increased, mostly due to the improvement of diagnostic work-up. In clinical practice, hypertensive subjects with suspicion of EAH currently undergo hormonal screening of the renin-aldosterone and catecholamines and glucocorticoids excess. This paper reviews current understanding for earlier recognition of the main forms of EAH and discusses screening laboratory methods and localization techniques that have enhanced the clinician's ability to make the diagnosis of EAH. Primary aldosteronism (PA) has recently been recognised as the most frequent cause of EAH. The aldosterone to renin ratio (ARR) is a highly recommended screening test for PA. When ARR is increased, confirmatory tests as saline infusion or fludrocortisone suppression are required. Differential diagnosis of PA requires adrenal gland imaging by computed tomography (CT) or magnetic resonance imaging (MRI), biochemical testing of the aldosterone response to posture, and selective adrenal venous sampling to differentiate unilateral aldosterone-producing adenoma from bilateral hyperplasia. Hypertension is frequently found in endogenous Cushing's Syndrome (CS). Twenty-four-hour urinary free cortisol measurement is the gold standard for the diagnosis of CS, but it must be confirmed by the overnight dexamethasone suppression test. CT and MRI are the primary imaging studies to perform, while scintigraphy is a useful confirmatory method. The most specific and sensitive diagnostic test for catecholamine-producing neoplasms is determination of urinary metanephrine levels; the neoplasms can be located by CT, MRI and metaiodo-benzylguanidine scintigraphy.
内分泌性动脉高血压（EAH）是一种因激素过量导致具有临床意义的高血压的病症，是高血压的罕见病因。然而，在过去几年中，其患病率有所上升，主要归因于诊断检查的改进。在临床实践中，怀疑患有EAH的高血压患者目前会接受肾素 - 醛固酮以及儿茶酚胺和糖皮质激素过量的激素筛查。本文回顾了目前对早期识别EAH主要形式的认识，并讨论了筛查实验室方法和定位技术，这些技术增强了临床医生诊断EAH的能力。原发性醛固酮增多症（PA）最近被认为是EAH最常见的病因。醛固酮与肾素比值（ARR）是PA高度推荐的筛查试验。当ARR升高时，需要进行盐水输注或氟氢可的松抑制等确诊试验。PA的鉴别诊断需要通过计算机断层扫描（CT）或磁共振成像（MRI）进行肾上腺成像、醛固酮对体位反应的生化检测以及选择性肾上腺静脉采血，以区分单侧醛固酮分泌腺瘤与双侧增生。高血压在内源性库欣综合征（CS）中很常见。24小时尿游离皮质醇测定是诊断CS的金标准，但必须通过过夜地塞米松抑制试验进行确认。CT和MRI是主要的影像学检查，而闪烁扫描是一种有用的确诊方法。对于产生儿茶酚胺的肿瘤，最特异和敏感的诊断试验是测定尿间甲肾上腺素水平；肿瘤可通过CT、MRI和间碘苄胍闪烁扫描定位。
