Lechner B, Heinrich D, Nölting S, Osswald-Kopp A, Rubinstein G, Sauerbeck J, Beuschlein F, Reincke M
Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Campus Innenstadt, Ziemssenstr. 1, 80336, München, Deutschland.
Klinik und Poliklinik für Nuklearmedizin, Klinikum der Universität München, München, Deutschland.
Internist (Berl). 2018 Nov;59(11):1163-1179. doi: 10.1007/s00108-018-0505-3.
Endocrine disorders are the most common causes of secondary hypertension. Early diagnosis and specific treatment are crucial for improvement of the prognosis. This article provides an overview on which clinical constellations point to an increased risk of secondary causes of hypertension. These include spontaneous hypokalemia, young age at onset of hypertension, adrenal incidentaloma and therapy refractive arterial hypertension. The basic diagnostics include determination of the aldosterone to renin ratio, measurement of free plasma metanephrines and a 1 mg dexamethasone suppression test. Borderline results require repeated control testing and/or confirmatory testing under standardized test conditions. In cases of repeatedly conspicuous results referral to a specialized clinic should be considered for further clarification and confirmation of the diagnosis. Imaging diagnostics may constitute an adjunct to laboratory testing after the diagnosis has been confirmed. Therapeutic algorithms vary depending on the underlying endocrine disease.
内分泌紊乱是继发性高血压最常见的病因。早期诊断和特异性治疗对于改善预后至关重要。本文概述了哪些临床症状提示继发性高血压病因风险增加。这些包括自发性低钾血症、高血压发病时年龄较轻、肾上腺偶发瘤和难治性动脉高血压。基本诊断包括测定醛固酮与肾素比值、测定游离血浆甲氧基肾上腺素以及进行1毫克地塞米松抑制试验。临界结果需要在标准化检测条件下重复对照检测和/或进行确诊检测。如果结果反复异常,应考虑转诊至专科诊所进行进一步的诊断澄清和确认。确诊后,影像学诊断可作为实验室检测的辅助手段。治疗方案因潜在的内分泌疾病而异。