原發性高醛固酮症之診斷與治療

10.6666/ClinMed.202110_88(4).0105

潘筱芳

次發性高血壓（secondary hypertension） ； 頑抗性高血壓（refractory hypertension） ； 頑固性高血壓（resistant hypertension） ； 原發性高醛固酮症（primary aldosteronism） ； adrenal venous sampling（AVS） ； 131 I-6β-iodomethyl-19-norcholesterol（NP-59）SPECT/CT

臨床醫學月刊

88卷4期（2021 / 10 / 29）

637 - 641

繁體中文

導致次發性高血壓最常見的原因是原發性高醛固酮症（primary aldosteronism, PA），其常見高血壓合併低血鉀症。但最近研究顯示只有50%的PA病人有低鉀血症。PA是因為自主過度分泌醛固酮素，可分為偶發性（sporadic）PA及3種家族性醛固酮過多症（familial hyperaldosteronism type I, II, III）。偶發性（sporadic）PA包括雙側腎上腺增生（bilateral adrenal hyperplasia, idiopathic adrenal hyperplasia, IHA）及醛固酮生成腺瘤（aldosterone-producing adenomas, APAs）。當懷疑PA時，先做ARR篩檢試驗（screening test），再做確定試驗Saline infusion test（SIT），oral sodium loading test, the captopril test, the fludrocortisone plus salt suppression test，upright furosemide-loading test，24-Hour urine aldosterone及random urinary aldosterone-to-creatinine ratio，abdominal CT來確診，adrenal venous sampling（AVS）或131 I-6β-iodomethyl-19-norcholesterol（NP-59）SPECT/CT的腎上腺核子醫學檢查則可協手術前定位準備。對於單側APA的病人，治療是用腹腔鏡腎上腺切除術。Type I家族性醛固酮過多症的治療以長效皮質類固醇或礦物性皮質素受體拮抗劑（mineralcorticoid receptor antagonists, MRA）為主。Type II家族性醛固酮過多症以腎上腺切除術或MRA來治療。Type III家族性醛固酮過多症以雙側腎上腺切除術或spironolactone來治療。患有雙側腎上腺增生（IHA）或不適合手術的患者，應使用MRA治療。

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