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題名 | 原發性皮質醛固酮症之診斷=Dignosis of Primary Aldosteronism |
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作者 | 黃建榮; 夏清智; 廖學崇; 李龍雄; Huang, Chien-jung; Shiah, Ching-jyh; Liao, Shue-tsong; Lee, Long-shyne; |
期刊 | 內科學誌 |
出版日期 | 19981200 |
卷期 | 9:4 1998.12[民87.12] |
頁次 | 頁175-183 |
分類號 | 415.934 |
語文 | chi |
關鍵詞 | 原發性皮質醛固酮症; 高血壓; 皮質醛固酮; 腎素; Primary aldosteronism; Hypertension; Aldosterone; Renin; |
中文摘要 | 傳統上估計原發性皮質醛固酮症(Primary aldosteronism)的罹患率約佔高血壓人 口的 0.05 %至 2 %, 近來的研究顯示原發性皮質醛固酮症的普遍性遠超過以往認知,且 次分類亦有所增加。尚未治療的高血壓併存低血鉀症雖為診察原發性皮質醛固酮症的指標, 然 7 %至 38 %患者的血鉀值大於 3.6meq/L 而易受忽略。 吾人可以血漿皮質醛固酮濃度 (Plasma aldosterone concentration) 和其與血漿腎素活性 (Plasma renin activity) 之 比值,必要時輔以 Captopril test,作為篩檢測試; 以口服或靜注氯化鈉負荷試驗作為確 診測試; 以腹部電腦斷層攝影或核磁共振攝影、 姿勢變化刺激後血漿皮質醛固酮濃度變化 (Postural stimulation test) 與 18-OH-corticosterone, 輔以 NP- 59 核醫造影及腎上 腺靜脈採血 (Adrenal venous sampling) 作為次分類鑑別診斷。 而診斷的目標在於確定功 能性病灶來源分側 (Lateralization) 與否,以為治療之依據。 |
英文摘要 | Prevalence of primary aldosteronism estimates ranged from 0.05%-2% of the population of hypertension traditionally. Recent studies suggest that primary aldosteronism may be more common than has been previous by believed. The prescence of hypokalemia in an untreated hypertension patient is an indication for further investigation of primary aldosteronism. However, between 7%-38% of patients with primary aldosteronism have been reported to have basal serum potassium level greater than 3.6 meq/L, which are prone to be neglected. The combination of plasma aldosterone concentration to plasma renin activity ratio and level of plasma aldosterone concentration, associated with captopril test, can be used for the screening tests. Oral or intravenous sodium chloride loading tests can be used for the confirmatory tests. Abdomen computer tomography or magnetic resonance imaging, variation of level of plasma aldosterone concentration in posture stimulation test, and leve of 18-OH-corticosterone, associated with NP-59 scintigraphy and adrenal venous sampling, can be used for the subtypes differentiation. Managenment of primary aldosteronism depends on whether the presence of "lateral- ization" of functional lesions. |
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