原發性高醛固酮症 (primary aldosteronism, PA) 是次發性高血壓常見但難以診斷 的原因。診斷仰賴繁瑣的血漿醛固酮濃度 (plasma aldosterone concentration) 與腎素 活性 (plasma renin activity) 之初步篩檢與確認測試。確診 PA 後，還需透過電腦斷層 掃描、核醫掃描或侵入性的導管腎上腺靜脈取樣 (adrenal venous sampling)，方可分 類過量醛固酮分泌的來源，是屬於可手術切除腎上腺的單側性亞型，例如醛固酮分泌 腺瘤 (aldosterone-producing adenoma)；或者屬於藥物控制為主的雙側性亞型，例如 特發性高醛固酮症 (idiopathic hyperaldosteronism）。本篇案例主要呈現 PA 診斷及 亞型分類時繁複的過程，不但需要適切的控制病人的血壓及低血鉀，還須同時需考量 到各種藥物對初步篩檢與確認測試判讀的影響，但適切的治療後不但可以矯正原本藥 物難以控制的高血壓與低血鉀，更可降低心血管併發症的風險。

 

Primary aldosteronism (PA) is one of the common etiologies of secondary hypertension. The diagnosis of PA relies on the complex process of measuring plasma aldosterone concentration and renin activity. Once confirmed the diagnosis of PA, subtype classification utilizing computed tomography, nuclear imaging, or invasive adrenal venous sampling is crucial to determine the lateralization of the secretory source of excess aldosterone. Unilateral subtype such as aldosterone-producing adenoma can be surgically treated, while bilateral subtype such as idiopathic hyperaldosteronism is treated by pharmacologic therapy. In this case report, we demonstrated a case of PA through a comprehensive process of initial detection, confirmatory test, and subtyping. The workup was undergone in consideration of antihypertensive medications that may confound the diagnostic tests. After appropriate diagnosis and surgical treatment, the patient benefited from cured hypertension, corrected hypokalemia, and potentially reduced cardiovascular risk.

 

Submited for publication: 2021.12.29; Accepted for publication: 2022.5.2