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題 名 | Aldosterone-Producing Adenoma: Clinical Presentation, Diagnosis and Outcomes of Surgery in Northern Taiwan=北臺灣的醛固酮分泌性腺瘤:病人的臨床表現、診斷及手術 |
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作 者 | 李秉衡; 吳志仁; 陳逸洲; 陳漢湘; | 書刊名 | 臺灣腎臟醫學會雜誌 |
卷 期 | 23:3 2009.09[民98.09] |
頁 次 | 頁143-148+185 |
分類號 | 416.273 |
關鍵詞 | 醛固酮分泌性腺瘤; 腎上腺切除術; 腎上腺皮質閃爍造影術; 腎上腺靜脈採樣; Aldosterone-producing adrenalectomyadenoma; Adrenal scintigraphy; Adrenal venous sampling; |
語 文 | 英文(English) |
英文摘要 | Background: Primary aldosteronism (PA) is a frequent cause of secondary hypertension and is common in nonselective hypertensive patients. The diagnosis of PA involves initial screening, confirmatory testing and differential testing to ascertain whether the underlying cause is adrenal hyperplasia or aldosterone-producing adenoma (APA), which can be surgically treated. Ethnic/racial differences may influence the presentation of PA. No study to date has reported the manifestations, diagnostic methods or outcomes following surgery in Northern Taiwanese patients with APA. Purpose: To summarize the clinical characteristics, diagnostic methods and outcomes of patients with APA in Northern Taiwan. Design: Retrospective review of charts from patients with adreno-cortical adenoma undergoing adrenalectomy between December 1991 and March 2007. Results: Twenty-five patients with APA met the inclusion criteria. The mean age at diagnosis was 42.0±9.2 years; younger than in previously published reports. Most patients presented with mineralocorticoid excess. Mean serum potassium levels were 2.5±0.7 mmol/L and the median aldosterone to renin ratio was 431.0 pmol/ng (range: 91.1 to 2358.8). Accurate APA was determined in 73.3% of patients using adrenal scintigraphy. There were no instances of intra-operative mortality. Adrenalectomy resulted in correction of hypokalemia in all patients and amelioration of hypertension in 52% of patients at 6 months follow-up. Conclusions: Adrenal scintigraphy plays an adjunctive role in PA subtype evaluation in Taiwan. Through applying defined assessment plans involving the use of screening techniques and confirmatory tests it may be possible to detect more cases of PA in Taiwan. This is important, as early detection can prevent and reduce the development of serious cardiovascular complications that can be both life-threatening and costly to treat. |
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