Bohdanowicz-Pawlak Anna, Szymczak Jadwiga, Jakubowska Joanna, Brona Anna
Katedra i Klinika Endokrynologii, Diabetologii i Leczenia Izotopami, Akademia Medyczna, Wrocław.
Endokrynol Pol. 2009 Nov-Dec;60(6):492-6.
In patients with primary aldosteronism (PA), it is fundamental to distinguish between subtypes that benefit from different treatment. The authors describe difficulties in differential diagnosis in a case of 46 year old women with PA and two strokes in the past. Based on high plasma and urine aldosterone concentration, low plasma renin activity (PRA), very high aldosterone/PRA ratio and unilateral macroadenoma detected in computed tomography, aldosterone producing adenoma was diagnosed and the patient was performed unilateral adrenalectomy. Despite the surgical treatment the patient still presented with clinical and biochemical PA symptoms. Moreover, histological examination suggested adrenal hyperplasia, and laboratory tests were typical for glucocorticoid-remediable aldosteronism. Unfortunately, we didn't find a chimeric CYP 11beta1/CYP 11beta2 gene. Finally, bilateral adrenal hyperplasia was diagnosed and medical treatment with aldosterone antagonist was initiated.
在原发性醛固酮增多症（PA）患者中，区分受益于不同治疗的亚型至关重要。作者描述了一名46岁患有PA且既往有两次中风的女性病例在鉴别诊断中的困难。基于高血浆和尿醛固酮浓度、低血浆肾素活性（PRA）、非常高的醛固酮/PRA比值以及计算机断层扫描检测到的单侧大腺瘤，诊断为醛固酮瘤并对患者实施了单侧肾上腺切除术。尽管进行了手术治疗，患者仍表现出临床和生化方面的PA症状。此外，组织学检查提示肾上腺增生，实验室检查结果符合糖皮质激素可纠正性醛固酮增多症。遗憾的是，我们未发现嵌合型CYP 11β1/CYP 11β2基因。最终，诊断为双侧肾上腺增生并开始使用醛固酮拮抗剂进行药物治疗。
