| Objective:To analyze the clinical characteristics and profile of lipid metabolism in patients with primary aldosteronism(PA), and to evaluate the value of ratio of plasma sodium-potassium, index of plasma sodium-potassium as predictors of PA or aldosterone producing adenoma(APA).Methods:The clinical data were retrospectively collected from 100 patients with PA confirmed by confirmatory testing or postoperational pathological examination from Feb. 2011 to Apr. 2015,of which 81 were adrenal cortical adenoma and 19 were cortical hyperplasia. Biochemical data,including lipid profile, plasma aldosterone concentration(PAC), adrenal imaging were recorded,compared with the patients with essential hypertension()EH and normotensives(NT).Results:1.90% of PA patients manifested with hypertension, among which 59.0% hypertensives were classified in level 3.2.The average PAC in PA patients were(21.97±6.53) ng/dl and(19.92±6.69) ng/dl in upright and supine position respectively, which were higher than those of the patients in EH group significantly[(17.18±6.93) ng/ml,(13.82±3.14) ng/ml,P<0.05,respectivly].However,there were no significant difference in PAC in upright and supine position between the adenoma and hyperplasia group [(22.43±6.56) ng/ml,( 20.53±6.53) ng/ml to(20.16±6.28)ng/ml,(17.18±6.93)ng/ml, P>0.05,respectivly].3.In PA patients, 50% were with hypertension and hypokalemia. The level of serum potassium was significant lower in adenoma group [3.23(2.57~3.95) mmol/L]than in adrenal hyperplasia group [3.80(3.60~4.18) mmol/L] and EH ones [4.05(3.82~4.35)mmol/L],while the level of serum sodium in adenoma group [()143.29±3.03 mmol/L]was higher than those in EH group[()141.77±2.95 mmol/L, P<0.05,respectivly.]4.In hypertensives, the cutpoints of plasma sodium to potassium ratio were 38.38, 41.04 for predicting PA or APA, respectively. Accordingly, the cutpoints of plasma sodium to potassium index for predicting PA or APA which were 0.974, 0.976, respectively. And the value of the predictors were almost equal to PAC.5.The levels of triglyceride[1.52(1.11~1.99) mmol/L] and very-low-density lipoprotein cholesterol(VLDL-C)[0.69(0.50~0.90) mmol/L] in hyperplasia group were higher than in adenoma group[1.11(0.81~1.53) mmol/L, 0.50(0.37~0.69) mmol/L,respectively, <,P 0.05 ] while the level of high-density lipoprotein cholesterol(HDL-C)in adenoma group[1.35(1.15~1.56) mmol/L mmol/L] was significant higher than those in hyperplasia group [1.10(0.95~1.31) mmol/L]and EH group[1.20(0.92~1.41) mmol/L,respectively,P<.0.05]6.Multiple Logistic regression analysis showed that high level of VLDL-C(OR 23.231)was the predictors of adrenal cortical hyperplasia. Neverthless,hypokalemia(OR 0.035)and high level of HDL-C(OR 0.060)were the predictor of adrenocortical adenoma(P<0.05,).respectively7. 90 PA patients have been performed with laparoscopic adrenal neoplasm resection, and the blood pressure in 67.78% of the patients dropped to the patients level after the surgery. The blood pressure dropped significantly after surgery from the baseline of 178.12±29.12/103.19±16.63 mm Hg to 134.64±15.75/82.80±10.65 mm Hg,P<0.05.Conclusions:90% of PA patients were characterized by the presence of high blood pressure. The patients with adrenal cortical adenoma were prone to be in a condition of hypokalaemia, while the patients with adrenal hyperplasia were susceptible to lipid metabolism disorders. The plasma sodium to potassium ratio and the plasma sodium to potassium index could be the predictors of PA or APA. Adrenal neoplasm resection is an effective method in lowering blood pressure in patients with PA. |
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