Tan S Y, Burton M
Arch Intern Med. 1981 Jan;141(1):30-3. doi: 10.1001/archinte.141.1.30.
To establish the frequency and clinical and biochemical characteristics of hyporeninemic hypoaldosteronism (HH), we reviewed 100 consecutive cases of hyperkalemia (potassium content > 5.3 mEq/L). The most common cause was end-stage renal failure (34%). Other causes included overzealous potassium replacement, spironolactone therapy, hemolysis, acute renal failure, acidosis, thrombocytosis, and Addison's disease. Ten of 19 patients with unexplained hyperkalemia showed suppressed renin (0.12 to 1.3 ng/mL/hr) and aldosterone (5.4 to 21.6 ng/dL) responses to furosemide-posture challenge. Cortisol reserve was normal in HH. Fludrocortisone acetate therapy corrected the hyperkalemia. Other features of HH include low serum bicarbonate content, mild renal insufficiency, diabetes, and advanced age. The use of indomethacin and ibuprofen was associated with one case of HH each. Results suggest that HH is an overlooked cause of hyperkalemia, especially in patients whose hyperkalemia is unexplained.
为确定低肾素性低醛固酮血症（HH）的发生率及其临床和生化特征，我们回顾了100例连续性高钾血症（血钾含量>5.3 mEq/L）病例。最常见的病因是终末期肾衰竭（34%）。其他病因包括补钾过度、螺内酯治疗、溶血、急性肾衰竭、酸中毒、血小板增多症和艾迪生病。19例不明原因高钾血症患者中有10例对速尿-体位激发试验显示肾素（0.12至1.3 ng/mL/小时）和醛固酮（5.4至21.6 ng/dL）反应受抑制。HH患者的皮质醇储备正常。醋酸氟氢可的松治疗纠正了高钾血症。HH的其他特征包括血清碳酸氢盐含量低、轻度肾功能不全、糖尿病和高龄。吲哚美辛和布洛芬的使用各与1例HH相关。结果表明，HH是高钾血症的一个被忽视的病因，尤其是在高钾血症原因不明的患者中。
