Berberich Amanda J, Penava Deborah, Sun Dongmei, MacDougall Arlene, Lum Andrea, Van Uum Stan
Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
Department of Obstetrics and Gynecology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
Obstet Med. 2020 Jun;13(2):88-91. doi: 10.1177/1753495X18786422. Epub 2018 Nov 4.
A 36-year-old woman presented at 16 weeks' gestation with severe hypertension. In comparison to the non-pregnant reference normal ranges, potassium was 3.1-3.9 mmol/L, aldosterone 2570-3000 pmol/L (N 250-2885) renin was unsuppressed (24-76.4 ng/L (N1.7-23.9)), with aldosterone to renin ratios in the reference range. An adrenal MRI scan demonstrated a 1.8 × 1.4 cm left adrenal adenoma. Primary aldosteronism was strongly suspected and surgery considered. However, she was managed conservatively with labetalol and modified-release nifedipine with no obstetric complications. Post-partum blood pressures remained elevated with normal aldosterone (539 pmol/L), unsuppressed renin (5.2 ng/L) and normal aldosterone-to-renin ratio (104 (N < 144)). Suspected primary hyperaldosteronism is challenging to investigate and manage in pregnancy. The accepted screening and confirmatory tests are either contraindicated or not validated in pregnancy. Pregnancy has significant effects on the renin-angiotensin-aldosterone pathway leading to physiologic elevations in both aldosterone and renin. While primary hyperaldosteronism has been associated with poor pregnancy outcomes, optimal management in pregnancy is not clearly established.
一名36岁女性在妊娠16周时出现严重高血压。与非妊娠参考正常范围相比，血钾为3.1 - 3.9 mmol/L，醛固酮为2570 - 3000 pmol/L（正常范围250 - 2885），肾素未被抑制（24 - 76.4 ng/L（正常范围1.7 - 23.9）），醛固酮与肾素比值在参考范围内。肾上腺MRI扫描显示左侧肾上腺有一个1.8×1.4 cm的腺瘤。强烈怀疑为原发性醛固酮增多症并考虑手术治疗。然而，她接受了拉贝洛尔和缓释硝苯地平的保守治疗，未出现产科并发症。产后血压仍高，醛固酮正常（539 pmol/L），肾素未被抑制（5.2 ng/L），醛固酮与肾素比值正常（104（正常范围<144））。妊娠期间怀疑原发性醛固酮增多症的检查和管理具有挑战性。公认的筛查和确诊试验在妊娠中要么禁忌要么未经验证。妊娠对肾素 - 血管紧张素 - 醛固酮途径有显著影响，导致醛固酮和肾素生理性升高。虽然原发性醛固酮增多症与不良妊娠结局有关，但妊娠期间的最佳管理尚未明确确立。
