The Second Department of Internal Medicine, University of Toyama, Japan.
Intern Med. 2023 Sep 15;62(18):2675-2680. doi: 10.2169/internalmedicine.1098-22. Epub 2023 Feb 1.
Malignant hypertension triggers incremental renin activity, whereas primary aldosteronism suppresses such activity. We encountered a patient with malignant hypertension refractory to multiple anti-hypertensive agents. Repeated neurohormonal assessments, instead of a single one, eventually uncovered trends in an incremental aldosterone concentration, ranging from 221 up to 468 pg/mL, with a decline in the renin activity from 2.3 to <0.2 ng/mL/h. Adrenal venous sampling confirmed bilateral aldosterone secretion. Following the diagnosis of bilateral primary aldosteronism, we initiated a mineralocorticoid receptor antagonist, which improved his blood pressure. Repeated neurohormonal assessments are encouraged to correctly diagnose underlying primary aldosteronism with malignant hypertension.
恶性高血压会引发肾素活性逐渐增加，而原发性醛固酮增多症则会抑制这种活性。我们遇到一位对多种降压药物均无反应的恶性高血压患者。重复的神经激素评估（而不是单次评估）最终揭示了醛固酮浓度逐渐增加的趋势，从 221 上升到 468 pg/ml，同时肾素活性从 2.3 下降到 <0.2ng/ml/h。肾上腺静脉采样证实为双侧醛固酮分泌。在诊断为双侧原发性醛固酮增多症后，我们开始使用盐皮质激素受体拮抗剂，这改善了他的血压。鼓励重复进行神经激素评估，以正确诊断恶性高血压伴发的潜在原发性醛固酮增多症。
