Department of Medicine, Armed Forces Taoyuan General Hospital, Taoyuan, Taiwan; Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Clin Chim Acta. 2013 Sep 23;424:114-8. doi: 10.1016/j.cca.2013.05.017. Epub 2013 May 28.
Hyperkalemia is a potentially serious complication following adrenalectomy of aldosterone-producing adenomas (APA). We analyzed the incidence and risk factors for hyperkalemia after adrenalectomy in patients with APA.
We retrospectively analyzed the records of 55 patients who underwent adrenalectomy for APA between 2002 and 2011. Demographic features, biochemical and hormonal profiles, imaging, and relevant medications were reviewed.
Sixteen of 55 APA patients (29.1%) developed hyperkalemia (mean serum K(+) 5.6±0.3 mmol/l) after adrenalectomy and 3 had persistent hyperkalemia requiring mineralocorticoid supplementation for more than nine months. Compared with normokalemic patients, hyperkalemic patients were characterized by male predominance, older age, longer duration of hypertension (12.8±9.3 vs. 6.7±5.0 y, p<0.05), lower nadir serum K(+) (p<0.05), higher preoperative serum creatinine (p<0.01), and higher likelihood of residual hypertension. Using multivariate regression analysis, longer duration of hypertension and impaired renal function were the most important factors of post-adrenalectomy hyperkalemia.
Post-adrenalectomy hyperkalemia in patients with APA is not rare and associated with impaired renal function and longer duration of hypertension. Serum K(+) must be cautiously monitored in patients with long-term hypertension and kidney disease.
醛固酮瘤（APA）患者行肾上腺切除术可能会导致高钾血症，这是一种潜在的严重并发症。我们分析了 APA 患者肾上腺切除术后高钾血症的发生率和危险因素。
我们回顾性分析了 2002 年至 2011 年间 55 例行肾上腺切除术治疗 APA 的患者的记录。评估了患者的人口统计学特征、生化和激素特征、影像学和相关药物治疗。
55 例 APA 患者中有 16 例（29.1%）在肾上腺切除术后发生高钾血症（平均血清钾 5.6±0.3mmol/L），其中 3 例持续高钾血症，需要补充盐皮质激素超过 9 个月。与血钾正常的患者相比，高钾血症患者以男性为主（66.7% vs. 33.3%），年龄较大（74.2±9.1 vs. 64.4±8.1 岁，p<0.05），高血压病程较长（12.8±9.3 vs. 6.7±5.0 年，p<0.05），最低血清钾水平较低（p<0.05），术前血清肌酐水平较高（p<0.01），且残余高血压的可能性更大。采用多变量回归分析，高血压病程较长和肾功能受损是术后高钾血症最重要的因素。
APA 患者术后高钾血症并不少见，与肾功能受损和高血压病程较长有关。对于长期高血压和肾病患者，必须密切监测血清钾。
