| Objective: To improve clinical physicians' knowledge on diagnosis, treatment and prognosis of primary aldosteronism (PA) .Methods: 180 patients with PA diagnosed in West China Hospital (WCH) from 1998 to 2006 were studied retrospectively based on their case histories .We calculated the constituent ratio of PA in all hypertension cases per year in WCH., analyzed the clinical characteristics of these cases including clinical symptoms, laboratory examinations, image examinations and treatment regimens. We calculated the plasm aldosterone to rennin ratio ( ARR) and the sensitivity as well as the specificity of diagnosis with different ARR cut-offs. The characteristics of the PA patients with adrenocortical adenoma were compared to that of the patients with adrenal hyperplasia. We analyzed the causes that influence status of hypertension after surgery by logistic regression analysis.Results:①180 patients were diagnosed as PA from 1998 to 2006. Male 62 cases and female 118 cases. Mean age 42.7±10.8 yr .The PA patients in WCH increased year by year. 128 of all cases were confirmed by pathological biopsy after operation, including 118 cases of aldosterone-producing adrenal adenoma (APA) , 9 cases of adrenal hyperplasia and 1 case aldosterone-producing adrenocortical carcinoma.②98% of PA patients had hypertension with average systolic pressure 161±16 mmHg and diastolic pressure101±12mmHg. 22.5%, 42.7% and 34.8% of the patients were at stagel, 2 and 3 of hypertension, respectively. 88.2% of patients represented persistent hypertension and 2.2% of patients had paroxysmal hypertension. The blood pressure fluctuated in patients with persistent hypertension (9.6%) .③96% of patients had hypokalemia with the mean concentration of 2.8±0.7mmol/L and 4% of patients had normal serum potassium. 14.1% of patients had hypokalemia before hypertension was diagnosed. 65.2% of patients had hypokalemia after hypertension was diagnosed. 20.6% of patients were found hypokalemia and hypertension at the same time.④The mean levels of supine and erect plasma rennin activity (PRA) were 0.12±0.18μg/L.h and 0.25±0.41μg/Lh, respectively. The mean level of supine and erect aldosterone (ALD) are 408±276ng/L and 445±300ng/L, respectively. Using ARR above 20 as the diagnostic cut-off, the sensitivity of diagnosis is 80%(supine) and 62%(erect) and the specificity is 87.5% (supine) and 95.8%(erect). Using ARR 50 as the diagnostic cut-off, the sensitivity is 54 %(supine) and 40%(erect), the specificity is 95.8%(supine) and 100%(erect), respectively.⑤The average BP was higher in the group with adrenocortical adenoma than in the group with adrenal hyperplasia(166±12 /102±11mmHg vs 155±20/95±15mmHg, P<0.05).The hypokalemia was more serious in the group with adrenocortical adenoma than in the group with adrenal hyperplasia patients(2.5±0.6mmol/L vs. 3.1±0.5mmol/L,P<0.05). The levels of supine and erect ALD were higher in the group with adrenocortical adenoma than in the group with hyperplasia [417±276ng/L vs. 295±96ng/L (supine) ,P< 0.05; 449±306 ng/L vs. 328±149 ng/L (erect) ,P<0.05)].⑥The veracity of diagnosis of CT scanning was 90%, MRI was 89% and B-ultrasonic was 28.6%.⑦145 patients were operated. BP of 64% of 145 patients was normalized. 18% of 145 patients needed antihypertensive drug to control BP after operation. Logistic regression analysis showed the course of hypertension is the risk factor of blood pressure increase after surgery. 8 cases accepted interventional therapy but 3 of which recurred in half to two years after the therapy.Conclusion:①PA is more common in middle-aged female. The hypertension is the commonest symptom in PA. Blood pressure moderately increase. Most patients had persistence hypertension and a few of PA patients have no hypertension. Hypokalemia often occurred after years during which patients had hypertension. Some patients have no hypokalemia.②ARRs have diagnostic value. Using ARR above 20 as the diagnostic cut-off, the sensitivity and the specificity for diagnosing PA are better than ARR above 50.③The clinical symptoms and laboratory examination are more obvious in the patients with adrenocotical adenoma than in the patients with adrenal hyperplasia.④CT scanning is helpful in differentiating the type and location of PA. The veracity of diagnosis of CT was relatively higher than that of B-ultrasonic.⑤Surgical treatment is the first choice for PA patients with adrenocotical adenoma .The course of hypertension is the risk factor of blood pressure increase after surgery. The long-term therapeutic effects of interventional therapy need further evaluation.
|
PDF Full Text Request