Kono T, Ikeda F, Oseko F, Imura H, Tanimura H
J Clin Endocrinol Metab. 1981 May;52(5):1009-13. doi: 10.1210/jcem-52-5-1009.
A 23-yr-old male patient with normotensive primary aldosteronism is reported. He complained of muscle weakness, polydipsia, and polyuria. His blood pressure was generally 118/60 to 124/70 mm Hg. Serum sodium, potassium and chloride were 152.2.2, and 108 meq/liter, respectively. Arterial blood pH, glomerular filtration rate, renal plasma flow and circulating plasma and blood volumes were normal, and plasma bicarbonate was normal or elevated. PRA was 0.16 ng/ml.h and did not increase significantly after sodium deprivation, ambulation, and iv furosemide injection. Plasma aldosterone was 64.1 ng/100 ml. He showed pressor responses to infused angiotensin II and norepinephrine which were similar to those in normal men. Adrenal scintiscanning after iv injection of [131I]6 beta-iodomethyl-19-nor-cholesterol during dexamethasone administration showed dense uptake on the right adrenal and minimal uptake on the left. Intravenous infusion of angiotensin III at a rate of 20 ng/kg. min for 30 min did not cause an increase in plasma aldosterone. Serum electrolytes became normal after spironolactone but not after dexamethasone. At surgery, the right adrenal, bearing a benign adenoma, was removed. After surgery, blood pressure was unchanged, but all biochemical abnormalities disappeared. The cause of this normotension remains to be elucidated, but the diagnosis criteria of primary aldosteronism should now be partly modified.
报告了一名23岁的原发性醛固酮增多症男性患者，血压正常。他主诉肌肉无力、烦渴和多尿。其血压一般为118/60至124/70 mmHg。血清钠、钾和氯分别为152、2.2和108 meq/升。动脉血pH值、肾小球滤过率、肾血浆流量以及循环血浆和血容量均正常，血浆碳酸氢盐正常或升高。血浆肾素活性（PRA）为0.16 ng/ml·h，在限钠、活动及静脉注射速尿后无明显升高。血浆醛固酮为64.1 ng/100 ml。他对输注的血管紧张素II和去甲肾上腺素的升压反应与正常男性相似。在给予地塞米松期间静脉注射[131I]6β-碘甲基-19-去甲胆固醇后进行肾上腺闪烁扫描，结果显示右侧肾上腺摄取密集，左侧摄取极少。以20 ng/kg·min的速率静脉输注血管紧张素III 30分钟，未引起血浆醛固酮升高。螺内酯治疗后血清电解质恢复正常，但地塞米松治疗后未恢复正常。手术切除了右侧肾上腺，其上有一个良性腺瘤。术后血压未变，但所有生化异常均消失。这种血压正常的原因尚待阐明，但原发性醛固酮增多症的诊断标准现在应部分修改。
