Zorzi Francesco, Olivieri Oliviero, Brazzarola Paolo, Pizzolo Francesca
Department of Medicine, School of Medicine, University of Verona, Policlinico "G.B. Rossi", P.le L.A. Scuro 10, 37134, Verona, Italy.
Department of Surgery and Oncology, School of Medicine, University of Verona, Verona, Italy.
High Blood Press Cardiovasc Prev. 2017 Sep;24(3):347-349. doi: 10.1007/s40292-017-0191-6. Epub 2017 Mar 14.
We report the case of a 41-year-old male patient with juvenile onset refractory hypertension while taking four drugs including a diuretic. Fourteen years before he underwent a complete investigation for secondary hypertension (including the aldosterone to renin ratio-ARR) that was negative. Since that, hypertension control gradually worsened, hypertensive organ damage aggravated and hypokalemia developed in spite of ACE inhibitor treatment. At the re-evaluation ARR was elevated, and the further workup for primary aldosteronism demonstrated an unilateral aldosterone producing adenoma that was surgically removed, with subsequent optimal blood pressure control with two anti-hypertensive drugs. In this case, the failure of the first screening prevented a correct diagnosis of primary aldosteronism, with consequent inadequate blood pressure control in following years and end organ damage. The case suggests the need of clinical follow-up and eventual reappraisal of patients showing a condition of refractory hypertension associated with hypokalemia despite a first negative screening test.
我们报告了一例41岁男性患者的病例，该患者患有青少年起病的难治性高血压，同时服用包括利尿剂在内的四种药物。14年前，他接受了全面的继发性高血压检查（包括醛固酮与肾素比值-ARR），结果为阴性。自那时起，尽管使用了ACE抑制剂治疗，但高血压控制逐渐恶化，高血压器官损害加重，并且出现了低钾血症。在重新评估时，ARR升高，对原发性醛固酮增多症的进一步检查显示为单侧醛固酮分泌腺瘤，该腺瘤通过手术切除，随后使用两种抗高血压药物实现了最佳血压控制。在该病例中，首次筛查失败妨碍了对原发性醛固酮增多症的正确诊断，导致随后几年血压控制不佳以及终末器官损害。该病例表明，对于尽管首次筛查试验为阴性，但仍表现为难治性高血压并伴有低钾血症的患者，需要进行临床随访并最终重新评估。
