Guthoff M, Schnauder G, Kirchhoff K, Kurth R, Horger M, Müssig K
Medizinische Universitätsklinik Tübingen, Abteilung für Endokrinologie, Diabetes, Nephrologie, Angiologie und Klinische Chemie.
Dtsch Med Wochenschr. 2009 Jul;134(31-32):1582. doi: 10.1055/s-0028-1082830. Epub 2009 Jul 23.
A 39-year-old patient presented with normokalaemic therapy refractory arterial hypertension despite of four antihypertensive drugs for further diagnostics.
Ultrasound displayed no evidence of renal artery stenosis. Furthermore, the kidneys were normal sized and morphologically without pathological findings. Renal function was normal. Free cortisol and catecholamine levels in a 24-hr-urine sample were within the normal range. Plasma renin activity was reduced and both the plasma aldosterone concentration and the aldosterone to renin ratio were elevated. A saline infusion test showed no suppression of the plasma aldosterone concentration, nor did an orthostatic testing show an increase. MRI revealed an adenoma of the right adrenal gland.
DIAGNOSIS, TREATMENT AND COURSE: The results were consistent with primary aldosteronism due to an aldosterone-producing adenoma of the adrenal gland. The patient underwent laparoscopic adrenalectomy. The histological findings confirmed an adenoma of the adrenal gland. Three months later, blood pressure was normal under a single treatment regimen with an AT(1) receptor blocker.
Screening for endocrine causes of hypertension is recommended in young patients, therapy refractory hypertension, and in hypokalaemic hypertension. Normokalaemia does not exclude primary aldosteronism as the underlying cause of hypertension.
一名39岁患者尽管使用了四种抗高血压药物，但仍出现了正常血钾性难治性动脉高血压，遂进行进一步诊断。
超声检查未发现肾动脉狭窄迹象。此外，双肾大小正常，形态学上无病理发现。肾功能正常。24小时尿样中的游离皮质醇和儿茶酚胺水平在正常范围内。血浆肾素活性降低，血浆醛固酮浓度及醛固酮与肾素比值均升高。生理盐水输注试验未显示血浆醛固酮浓度受到抑制，直立试验也未显示升高。磁共振成像（MRI）显示右侧肾上腺有一个腺瘤。
诊断、治疗及病程：结果符合肾上腺醛固酮分泌腺瘤所致的原发性醛固酮增多症。患者接受了腹腔镜肾上腺切除术。组织学检查结果证实为肾上腺腺瘤。三个月后，在单一使用AT(1)受体阻滞剂的治疗方案下，血压恢复正常。
建议对年轻患者、难治性高血压患者及低钾性高血压患者筛查高血压的内分泌病因。正常血钾并不能排除原发性醛固酮增多症作为高血压的潜在病因。
