Shiroto H, Ando H, Ebitani I, Hara M, Numazawa K, Kawamura S, Sasaki H
Am J Med. 1980 Oct;69(4):603-6. doi: 10.1016/0002-9343(80)90474-x.
A very unusual case of normotensive primary aldosteronism is described. A 25 year old woman first noticed numbness of both hands followed by a typical tetany attack. The blood pressure was within normal ranges. The results of other physical examinations were negative except for the findings of Trousseau's sign. Hypokalemi, increased potassium clearance, disturbed urine concentration and increased circulating plasma volume were noticeable. Diagnosis was established by (1) increased levels of plasma aldosterone, (2) low plasma renin activity, (3) normal adrenocortical function and (4) typical aldosterone-producing adenoma. After removal of the adenoma, the abnormalities subsided. The lack of hypertension in primary aldosteronism is a rare condition. Several possible causes of normotension must be considered, such as the early phase of primary aldosteronism, essential hypotension associated with primary aldosteronism and lack of concomitant secretion of other mineralocorticoids from the adenoma, but these were all negligible. As blood pressure response to the administration of angiotensin II was lower than is typical for primary aldosteronism, and the patient transiently suffered from frequent attacks of blackouts soon after the operation, the cause of normotension was thought to be due to the existence of a hypotensive mechanism which counteracts the increase in blood pressure in primary aldosteronism.
本文描述了一例非常罕见的血压正常的原发性醛固酮增多症病例。一名25岁女性最初注意到双手麻木，随后出现典型的手足搐搦发作。血压在正常范围内。除了陶瑟征阳性外，其他体格检查结果均为阴性。低钾血症、钾清除率增加、尿液浓缩功能障碍和循环血浆容量增加较为明显。诊断依据为：（1）血浆醛固酮水平升高；（2）血浆肾素活性降低；（3）肾上腺皮质功能正常；（4）典型的醛固酮瘤。切除腺瘤后，异常情况消失。原发性醛固酮增多症患者无高血压是一种罕见情况。必须考虑几种可能导致血压正常的原因，如原发性醛固酮增多症的早期阶段、与原发性醛固酮增多症相关的原发性低血压以及腺瘤缺乏其他盐皮质激素的伴随分泌，但这些原因均微不足道。由于对血管紧张素II给药的血压反应低于原发性醛固酮增多症的典型情况，且患者术后不久短暂出现频繁的昏厥发作，因此认为血压正常的原因是存在一种降压机制，该机制可抵消原发性醛固酮增多症中血压的升高。
