小结
定义
病史和体格检查
关键诊断因素
- hypertension
其他诊断因素
- age 20 to 70 years
- nocturia, polyuria
- lethargy
- mood disturbance (irritability, anxiety, depression)
- difficulty concentrating
- paresthesias, muscle cramps
- muscle weakness
- palpitations
危险因素
- family history of PA
- family history of early onset of hypertension and/or stroke
诊断性检查
首要检查
- plasma potassium
- aldosterone/renin ratio
需考虑的检查
- oral salt loading test
- saline infusion testing
- genetic testing
- adrenal CT
- adrenal venous sampling
- adrenal MRI
- posture stimulation testing
- angiotensin II infusion testing
- 24-hour urinary hybrid steroids (18-hydroxy- and 18-oxo-cortisol)
- dexamethasone suppression testing
新兴检查
- ¹¹ C-Metomidate PET/CT
治疗流程
unilateral PA
bilateral PA (excluding familial hyperaldosteronism type I)
familial hyperaldosteronism type I
撰稿人
作者
Michael Stowasser, MBBS, FRACP, PhD
Professor
Endocrine Hypertension Research Centre
University of Queensland Frazer Institute
Greenslopes and Princess Alexandra Hospitals
Brisbane
Queensland
Australia
利益声明
MS is an author of several references cited in this topic.
鸣谢
Professor Michael Stowasser would like to gratefully acknowledge Professor Richard D. Gordon, a previous contributor to this topic.
同行评议者
Paolo Mulatero, MD
Department of Medicine and Experimental Oncology
Division of Medicine and Hypertension
San Giovanni Battista Hospital
Torino
Italy
利益声明
PM declares that he has no competing interests.
Wail Malaty, MD
Clinical Professor
Department of Family Medicine
University of North Carolina
Chapel Hill
Assistant Program Director
MAHEC Rural Family Medicine Residency
Hendersonville
NC
利益声明
WM declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
Mulatero P, Sechi LA, Williams TA, et al. Subtype diagnosis, treatment, complications and outcomes of primary aldosteronism and future direction of research: a position statement and consensus of the Working Group on Endocrine Hypertension of the European Society of Hypertension. J Hypertens. 2020 Oct;38(10):1929-36. 摘要
Reincke M, Bancos I, Mulatero P, et al. Diagnosis and treatment of primary aldosteronism. Lancet Diabetes Endocrinol. 2021 Dec;9(12):876-92. 摘要
Funder JW, Carey RM, Mantero F, et al. The management of primary aldosteronism: case detection, diagnosis, and treatment. J Clin Endocrinol Metab. 2016 May;101(5):1889-916.全文 摘要
Young WF Jr. Diagnosis and treatment of primary aldosteronism: practical clinical perspectives. J Intern Med. 2019 Feb;285(2):126-48.全文 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
鉴别诊断
- Essential hypertension (HTN)
- Thiazide-induced hypokalemia in patient with essential HTN
- Renal artery stenosis
更多 鉴别诊断指南
- NCCN clinical practice guidelines in oncology: neuroendocrine and adrenal tumors
- Japan Endocrine Society clinical practice guideline for the diagnosis and management of primary aldosteronism 2021
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