Diagnosis-hyperaldosteronism

(JCEM 2016;101:1889; Endo Metab Clin 2019;48:681; J Clin Endo Met 2021;106:2423)

• 5–10% of Pts w/ HTN; ∴ screen if HTN + hypoK, adrenal mass, refractory/early onset HTN
• Screening of hyperaldosteronism:
• ACEI/ARB, diuretics, CCB can ↑ renin activity
  • → ↓ PAC/PRA ratio and
• βBs may ↑ PAC/PRA ratio;
  • ∴ avoid. α-blockers generally best to control HTN during dx testing.
• Confirm with sodium suppression test (fail to suppress aldo after sodium load) oral salt load (+ KCl) × 3 d,
  • ✓ 24-h urine (⊕ if urinary aldo >12 µg/d while urinary Na >200 mEq/d) or 2L NS over 4 h,
  • measure plasma aldo at end of infusion (⊕ if aldo >5 ng/dL); >10 幾乎就是確診了

Approache to suspected hyperaldosteronism

• NOTE: Figure 7-4 Approach to suspected hyperaldosteronism
• 內科學誌 zotero://select/library/items/69HWH8FF

臨床上、看到下面幾點應該要開始懷疑 🤔

1. 高血壓合併低血鉀 : HTN + HypoK
2. 頑固性高血壓 : r/r HTN
3. 腎上腺瘤合併高血壓: adrenal tumor + HTN
4. 小於 20 歲之年輕人高血壓: young HTN
5. 嚴重高血壓（收縮壓大於 160 毫米汞柱或舒張壓大於 100 毫米汞柱）: severe HTN
6. 懷疑是次發性高血壓 : ? 2’HTN
7. 高血壓合併左心室肥大: HTN + LVH

第一第可以先抽血 PAC/PRA ratio (ARR) 決定是不是原發的

• PAC to PRA ratio
• (受一些血壓藥的影響) CCB, bB, aB

confirmation of the diagnosis 接著做下面四個測驗：我推薦第一個

1. 口服鈉鹽負載試驗(oral sodium loading test),
2. 靜脈生理食鹽水輸注 試驗(intravenous saline infusion test),
3. Fludrocortisone 抑制試驗(Fludrocortisone suppression test),
4. Captopril test

確診1° Hyperaldosteronism

• Adrenal CT or MRI
  • suspect carcinoma, lesion >4 cm: Recommend surgery
  • unilateral lesion: Probable Adenoma: Adrenal vein sampling
  • no or bilateral lesions