原发性醛固酮增多症的诊断和治疗进展课件

Case Detection, Diagnosis, and Treatment of Patients with Primary Aldosteronism: An Endocrine Society Clinical Practice Guideline 原发性醛固酮增多症的病例检测、诊断和治疗：内分 泌学会临床实践指南 - J Clin Endocrinol Metab， 2008， 93（9）： 32663281 几个问题 PA发病率及临床意义： 10% 更高的心脑血管疾病发病率及死亡率； 特异性治疗可改善预后 PA中低钾血症的发生率 ARR测定方法及截点确定 PA确诊试验与分型诊断 病例筛查Case detection 高发人群 1|OO PA一级亲属合并高血压者 1|OOO 筛查方法ARR 1|OO 确诊试验Case confirmation 4个确诊试验之一即可 1|OO 亚型分类及定位Subtype classification 肾上腺CT 1|OO 肾上腺静脉采血 1|O 基因测定 1|OO 治疗Treatment 单侧腹腔镜 1|OO 双侧或不能手术用MR拮抗剂1|OO 螺内酯首选Eplerenone备选2|OOO GRA小剂量糖皮质激素 1|OOO 1.0 Case Detection 1.1 We recommend the case detection of PA in patient groups with relatively high prevalence of PA (listed in Table 1) (Fig. 1). We also recommend case detection for all hypertensive first-degree relatives of patients with PA. (1QOOO) 1.2 We recommend use of the plasma ARR to detect cases of PA in these patient groups (Fig. 1). (1QQOO) 2.0 Case Confirmation 2.1 Instead of proceeding directly to subtype classification, we recommend that patients with a positive aldosterone-renin ratio (ARR) measurement undergo testing, by any of four confirmatory tests, to definitively confirm or exclude the diagnosis (Fig. 1). (1QQOO) 3.0 Subtype Classification 3.1 We recommend that all patients with PA undergo an adrenal CT scan as the initial study in subtype testing and to exclude large masses that may represent adrenocortical carcinoma (Fig. 1). (1QQOO) 3.2 We recommend that, when surgical treatment is practicable and desired by the patient, the distinction between unilateral and bilateral adrenal disease be made by AVS by an experienced radiologist (Fig. 1). (1QQQO) 3.3 In patients with onset of confirmed PA earlier than at 20 yr of age and in those who have a family history of PA or of strokes at young age, we suggest genetic testing forGRA(Fig. 1). (2QOOO) 4.0 Treatment 4.1 We recommend that unilateral laparoscopic adrenalectomy be offered to patients with documented unilateral PA (i.e. APA or UAH) (Fig. 1). (1QQOO) If a patient is unable or unwilling to undergo surgery, we recommend medical treatment with an MR antagonist (Fig. 1). (1QQOO) 4.2 In patients with PA due to bilateral adrenal disease, we recommend medical treatment with an MR antagonist (1QQOO); we suggest spironolactone as the primary agent with eplerenone as an alternative (Fig. 1). (2QOOO) 4.3 In patients with GRA,werecommend the use of the lowest dose of glucocorticoid