| Objective: To promote and improve the knowledge on diagnosis and treatment of primary aldosteronism (PA), the clinical characteristics of thirty cases of PA were reviewed. Methods: Thirty patients (14 males and 16 females) with PA who had been treated in Hypertension Unit of Xinjiang People's Hospital from 1997 to 2004 were studied retrospectively, including 27 Hans, 2 Uigurs and 1 Hui nationality. The cases were at ages from 27 to 66 yr with a mean age of (42.9± 10.5) yr and with a mean course of hypertension of (5.75±5.47) yr. 16 cases of PA were confirmed by pathological examination after operation, including 15 cases of aldosterone-producing adenoma(APA) and 1 case of primary adrenal hyperplasia (PAH). 14 cases of PA were diagnosed by clinical evidences, including 10 cases of APA and 4 cases of idiopathic hyperaldosteronism (IHA). We analysed and summarized the clinical characteristics of these cases including their clinical symptom, results of laboratory, assistant examination, clinical tests and treatment. Results: (1) All cases of PA had suffered hypertension and 93.3% patients suffered as initial symptom, 20.0%, 56.7% and 23.3% of patients were at stage 1, 2 and 3 of hypertension respectively. 16.7% of patients represented resistant hypertension and 3 cases of PA had long been diagnosed as essential hypertension by error. 53.3% of patients had weakness or periodic paralysis, and 30% of patients had nocturia. (2) 83.3% of patients had hypokalemia with the mean concentration of (2.81±0.49) mmol/1 and had relatively higher urine potassium excretion with the mean level of (51.9±38.0) mmol/24h. 93.3% of patients had hypernatremia4with the mean concentration of (145.0±4.84) mmol/1. (3) The mean level of supine and erect plasma renin activity (PRA) were in a low-normal level and the mean level of supine and erect aldosterone(ALD) were higher than normal level. The mean level of erect aldosterone increased 28.6% compared with supine aldosterone(P > 0.05). 90.0% of patients with PA had increased aldosterone/ renin ratio(ARR) over 25 and 83.3% of cases with PA over 50. (4) The veracity of diagnosis on B-ultrasonic was relatively low(50.0%), while on CT scanning was high (96.6%). 2 patients with PA had undergone a drenal venous sampling (AVS) to to distinguish the type and side of PA. (5) 43.3% of patients with PA have cardiac and renal impairment, 50% patients were found 2-degree arteriosclerosis of eyeground in 12 cases who had eyeground examination and stoke was found in 6.7% patients. (6) 15 cases of APA and 1 case of PHA received surgical treatment, except 2 cases had to take spironolactone after operation, all others had fine curative effect. 4 cases of IHA and 10 cases of APA choosed long-term administration of antihypertensive medicine. Conclusion: PA can be diagnosed by its typical clincal manifestation such as hypertension, hypokalemia, hyper-aldosteronism, low plasma renin activity and increased ARR and so on, CT scanning and clinical tests administer to differentiate the type and side of PA. Adrenal venous sampling (AVS) can be used when it is necessary. Complications of hypertension were common in patients with PA. Surgical treatment is the first choice for patients with APA or PAH., but isn't fit for patients with IHA, who had better choose long-term treatment with antihypertensive medicine.
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