Vakkalanka Sujit, Zhao Andrew, Samannodi Mohammed
University at Buffalo, Buffalo, New York, USA.
Department of Medicine, Buffalo, New York, USA.
BMJ Case Rep. 2016 Jul 14;2016:bcr2016216209. doi: 10.1136/bcr-2016-216209.
Primary hyperaldosteronism is one of the most common causes of secondary hypertension but clear differentiation between its various subtypes can be a clinical challenge. We report the case of a 37-year-old African-American woman with refractory hypertension who was admitted to our hospital for palpitations, shortness of breath and headache. Her laboratory results showed hypokalaemia and an elevated aldosterone/renin ratio. An abdominal CT scan showed a nodule in the left adrenal gland but adrenal venous sampling showed elevated aldosterone/renin ratio from the right adrenal vein. The patient began a new medical regimen but declined any surgical options. We recommend clinicians to maintain a high level of suspicion to consider the less common subtypes of primary hyperaldosteronism, especially given the fact that the management greatly varies.
原发性醛固酮增多症是继发性高血压最常见的病因之一，但明确区分其各种亚型可能是一项临床挑战。我们报告了一例37岁的非裔美国女性难治性高血压患者，她因心悸、气短和头痛入住我院。她的实验室检查结果显示低钾血症和醛固酮/肾素比值升高。腹部CT扫描显示左肾上腺有一个结节，但肾上腺静脉采血显示右肾上腺静脉的醛固酮/肾素比值升高。患者开始了新的药物治疗方案，但拒绝了任何手术选择。我们建议临床医生保持高度怀疑，考虑原发性醛固酮增多症较不常见的亚型，尤其是考虑到治疗方法差异很大这一事实。
