Komiya I, Yamada T, Aizawa T, Takasu N, Niwa A, Maruyama Y, Ogawa A
Department of Geriatrics, Shinshu University School of Medicine, Nagano, Japan.
Cardiology. 1991;78(2):99-110. doi: 10.1159/000174773.
Among 436 patients with hypertension unrelated to any renal lesion, renovascular damage, pheochromocytoma, Cushing's syndrome or hyperthyroidism, 15 patients had low plasma renin activity (PRA) and elevated plasma aldosterone concentrations in the upright position and resultant high aldosterone/PRA ratios: 8 with aldosterone-producing adenoma (APA; group 1) and 7 with idiopathic hyperaldosteronism (IHA; group 2). Thirty-nine patients had suppressed PRA in the presence of normal plasma aldosterone levels and moderately elevated aldosterone/PRA ratios (group 3). Thirty of them had elevated plasma 11-deoxycorticosterone (DOC) and 18-hydroxy-11-deoxycorticosterone (18-OH-DOC) concentrations (group 3a) and 9 of them had normal levels of those mineralocorticoids (group 3b). The rest of them (382 patients) had low aldosterone/PRA ratios (group 4). Adrenal scintigraphy with dexamethasone pretreatment revealed [13I]-cholesterol accumulation not only in patients with APA (unilateral) or IHA (bilateral), but also in patients of group 3a (bilateral). In patients in groups 3a and 3b adrenal size (especially thickness), as measured by computed tomography (CT scan), was enlarged, as in patients with IHA (group 2), and was significantly greater than in patients of group 4 (p less than 0.001). Spironolactone reduced blood pressure in all tested patients of group 3a, and the removal of adrenal tumor or hyperplastic tissue normalized blood pressure in patients of groups 1, 2 and 3a. Excised adrenal glands exhibited cortical hyperplasia with or without nodular hyperplasia in patients of group 3a. Good agreement was found between the actual size of the excised tissue and the measurement obtained by CT scan. Since beta-endorphin and beta-lipotropin were depressed in patients of group 3a, it is suggested that an unknown pituitary substance stimulates the adrenal cortex to release too large amounts of DOC and 18-OH-DOC and inappropriate secretion of aldosterone.
在436例与任何肾脏病变、肾血管损害、嗜铬细胞瘤、库欣综合征或甲状腺功能亢进无关的高血压患者中，15例患者在直立位时血浆肾素活性（PRA）降低，血浆醛固酮浓度升高，导致醛固酮/PRA比值升高：8例为醛固酮瘤（APA；第1组），7例为特发性醛固酮增多症（IHA；第2组）。39例患者在血浆醛固酮水平正常且醛固酮/PRA比值中度升高的情况下PRA受到抑制（第3组）。其中30例患者血浆11 - 脱氧皮质酮（DOC）和18 - 羟 - 11 - 脱氧皮质酮（18 - OH - DOC）浓度升高（第3a组），9例患者这些盐皮质激素水平正常（第3b组）。其余患者（382例）醛固酮/PRA比值较低（第4组）。地塞米松预处理后的肾上腺闪烁显像显示，[13I] - 胆固醇不仅在APA患者（单侧）或IHA患者（双侧）中蓄积，在第3a组患者（双侧）中也有蓄积。通过计算机断层扫描（CT扫描）测量，第3a组和第3b组患者的肾上腺大小（尤其是厚度）增大，与IHA患者（第2组）一样，且显著大于第4组患者（p < 0.001）。螺内酯使第3a组所有受试患者的血压降低，切除肾上腺肿瘤或增生组织使第1、2和3a组患者的血压恢复正常。第3a组患者切除的肾上腺显示皮质增生伴或不伴结节性增生。切除组织的实际大小与CT扫描测量结果之间具有良好的一致性。由于第3a组患者的β - 内啡肽和β - 促脂素降低，提示一种未知的垂体物质刺激肾上腺皮质释放过多的DOC和18 - OH - DOC以及醛固酮分泌异常。
