Zhang Yunuo, Ni Wenjuan, Wang Wei
Department of Endocrinology, First Affiliated Hospital of Baotou Medical Collage, Baotou, China.
Department of Hematology, First Affiliated Hospital of Baotou Medical Collage, Baotou, China.
AME Case Rep. 2023 Dec 19;8:20. doi: 10.21037/acr-23-103. eCollection 2024.
Primary aldosteronism (PA) is one of the main causes of secondary endocrine hypertension, especially refractory hypertension. Increased autonomous secretion leads to increased blood pressure and proinflammatory effects on different organ systems, including the cardiovascular system. However, because of its diverse clinical manifestations or the combination of other conditions, it sometimes causes problems for correct diagnosis. Therefore, we report and review the characteristics of some atypical and uncommon special case cases related to proaldosterone to provide clinical ideas for correct diagnosis and decision-making of proaldosterone.
A 38-year-old male patient with fatigue and bilateral lower extremity pain came to the clinic and was found to have abnormal thyroid function, low blood potassium, elevated blood pressure, and also combined with rhabdomyolysis (RM) after further improvement of functional tests and imaging tests was diagnosed with an adrenal cortical adenoma (aldosteronism), hypertension secondary to PA, hypokalemia secondary to PA, RM, and subacute thyroiditis. After laparoscopic resection of a unilateral adrenal adenoma, the patient's blood pressure and blood potassium gradually returned to normal, and thyroid function returned to normal without additional intervention.
Early screening should be performed for the high-risk population of PA to prevent the occurrence of RM and other serious complications caused by the progression of the disease. For patients with RM, the primary disease should be approached radically and should be based on symptomatic treatment. For RM syndrome associated with thyroid dysfunction, the etiology of the thyroid dysfunction should be actively identified to guide appropriate clinical management.
原发性醛固酮增多症(PA)是继发性内分泌性高血压的主要病因之一,尤其是难治性高血压。自主分泌增加导致血压升高,并对包括心血管系统在内的不同器官系统产生促炎作用。然而,由于其临床表现多样或合并其他病症,有时会给正确诊断带来困难。因此,我们报告并回顾一些与原醛相关的非典型和罕见特殊病例的特征,为原醛的正确诊断和决策提供临床思路。
一名38岁男性患者因疲劳和双侧下肢疼痛前来就诊,经进一步完善功能检查及影像学检查后,发现甲状腺功能异常、血钾低、血压高,还合并横纹肌溶解症(RM),诊断为肾上腺皮质腺瘤(醛固酮增多症)、PA继发性高血压、PA继发性低钾血症、RM及亚急性甲状腺炎。经腹腔镜切除单侧肾上腺腺瘤后,患者血压和血钾逐渐恢复正常,甲状腺功能未进行额外干预即恢复正常。
应对PA高危人群进行早期筛查,以预防疾病进展导致RM等严重并发症的发生。对于RM患者,应从根本上治疗原发疾病,且应以对症治疗为基础。对于合并甲状腺功能障碍的RM综合征,应积极明确甲状腺功能障碍的病因,以指导适当的临床管理。