頁籤選單縮合
題 名 | The Syndrome of Isolated Hypoaldosteronism in Adult=成人單獨性低醛固酮症候群 |
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作 者 | 夏清智; 蔡東銘; 黃哲勇; 廖學崇; 許重輝; 蕭泉豹; 李龍雄; | 書刊名 | 中華民國腎臟醫學會雜誌 |
卷 期 | 8:2 1994.06[民83.06] |
頁 次 | 頁110-118 |
分類號 | 415.934 |
關鍵詞 | Hypoaldosteronism; Hyporeninemia; Hyponatremia; Hyperkalemia; |
語 文 | 英文(English) |
中文摘要 | 成人單獨性低藍固酮症候群是低血鈉及高血鉀症中罕見的病因,在台灣亦僅有零星的病例報告。我們回溯性研究十八個症例,結果年齡平均六十七歲、 Ccr 平均 38ml/min 、最低血鈉及最高血鉀值平均122和5.2mEq/L,50%有高氯血性酸中毒。主要的潛在疾病為糖尿病(67%)、腎臟疾病 (67%) 和自主神經病變 (28%)。臨床症狀以腸胃不適 (44%),肌肉無力(39%),意識不清 (28%),及姿勢性低血壓 (28%) 最多。這和文獻報告相似,最大差異有二:較多且嚴重的低鈉血症,較少無症狀的高鉀血症表現。可能因我們的病人是住院病人併有多重疾病,以致鈉、鉀的攝取不足。另外,低鈉血症者較以高餌血症表現者有較嚴重低醛固酮、較常有嘔吐、反胃及鈉鹽攝取不足。83% 低醛固酮病因歸於低腎素所致,和文獻報告相近。而腎臟病變、糖尿病、年齡老化及自主神經病變對腎素值有負影響:且此四者相互關連,彼此加重低腎素血症的形成。臥姿醛固酮值和正常值重壘,無法單獨用以診斷低醛固酮症。而 FEK和尿中鈉鉀比值和臥姿或刺激後醛固酮值都無相關性。反之,血中醛酤酮與血鉀比值和臥姿及刺激後醛固酮值有很好相關性,可幫助診斷低醛固酮症。有5人接受 f1udrocortisone 補充, 主要用於有嚴重低血鈉或姿勢性低血壓者;有5人 接受鈉鉀離子交換樹脂,主要用於高鉀血症;其餘症狀較輕者則給予高鹽低鉀飲食,皆有不錯的療效。 |
英文摘要 | The syndrome of isolated hypoalclosteronism (IH) in adult is an uncommon cause of hyponatremia and hyperkalemia. We retrospectively studied 18 cases (9M, 9F) with mean age of 67±15 (mean±SEM) and Ccr 38±20 m $ / min. The lowest serum Na averaged 122±8 and highest K 5.2±0.6 mEq/L. Clinical manifestations included GI upset (44%), muscle weakness (39%), consciousness change (28%), orthostatism (28%) and asymptomatic (33%). Hyperchloremic metabolic acidosis existed in 9 cases. The underlying diseases included diabetes mellitus (DM) (67%), renal diseases (67%), autonomic neuropathy (28%) hypertension(HT) (17%) and others. Seven cases manifesting hyponatremia mainly had lower supine and stimulated plasma aldosterone concentration(PAC) than the others, and had higher prevalence of salt restriction. Fifteen cases (83%) had hyporeninemia.The mean plasma renin activity (PRA) was 0.96 ± 1.32 ng / ml / h. The supine PAC ranged from 1.2 to 13.7 ng / dl (6.06±3.58) which overlapped with normal limits. The simulated PRA and PAC ranged from 0.02 to 10.5 ng/ml/h (1.77±2.46) and from 1.2 to 19 ng/dl (7.38± 5.51). They were blunted responses. To study the causes of hyporeninemia, we found that Ccr had a positive correlation with both of supine (r=0.69) and stimulated PRA (r=0.64). The patients aged over 65 had lower supine PRA than those under 65. Also, patents having autonomic neuropathy had lower supine PRA than those without, and those with DM had lower stimulated PRA. We also calculated several postulated diagnostic indexes and found that neither fractional K excretion (FEK) nor ratio of 24-h urinary excretion of Na to K (UNa/Uk) was correlated with supine or stimulated PAC, while ratio of supine PAC to serum k (PAC/K) correlated well with both supine (r=0.91) and stimulated PAC (r=0.53). Treatments included fludrocortisone replacement in 5, K-binding resin in 5 and diet modification alone in 8 cases. In conclusion, IH occurs commonly in aged patents with renal insufficiency and DM, and manifests either hyponatremia or hyperkalemia. Hypoaldosteronism is mostly attributed to hyporeninemia, which is accounted for aging, renal diseases, DM or autonomic neuropathy. The diagnosis cannot be based solely on supine PAC. FEK or UNa/Uk cannot help diagnose but PAC/K can. |
本系統中英文摘要資訊取自各篇刊載內容。