原发性醛固酮增多症的诊断和治疗进展ppt课件

CaseDetection Diagnosis andTreatmentofPatientswithPrimaryAldosteronism AnEndocrineSocietyClinicalPracticeGuideline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 JClinEndocrinolMetab 2008 93 9 3266 3281 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Casedetection高发人群1 OOPA一级亲属合并高血压者1 OOO筛查方法ARR1 OO确诊试验Caseconfirmation4个确诊试验之一即可1 OO亚型分类及定位Subtypeclassification肾上腺CT1 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 OOOGRA小剂量糖皮质激素1 OOO 1 0CaseDetection1 1WerecommendthecasedetectionofPAinpatientgroupswithrelativelyhighprevalenceofPA listedinTable1 Fig 1 2 0CaseConfirmation2 1Insteadofproceedingdirectlytosubtypeclassification werecommendthatpatientswithapositivealdosterone reninratio ARR measurementundergotesting byanyoffourconfirmatorytests todefinitivelyconfirmorexcludethediagnosis Fig 1 1QQOO 3 0SubtypeClassification3 1WerecommendthatallpatientswithPAundergoanadrenalCTscanastheinitialstudyinsubtypetestingandtoexcludelargemassesthatmayrepresentadrenocorticalcarcinoma Fig 1 1QQOO 3 2Werecommendthat whensurgicaltreatmentispracticableanddesiredbythepatient thedistinctionbetweenunilateralandbilateraladrenaldiseasebemadebyAVSbyanexperiencedradiologist Fig 1 1QQQO 3 3InpatientswithonsetofconfirmedPAearlierthanat20yrofageandinthosewhohaveafamilyhistoryofPAorofstrokesatyoungage wesuggestgenetictestingforGRA Fig 1 2QOOO 4 0Treatment4 1WerecommendthatunilaterallaparoscopicadrenalectomybeofferedtopatientswithdocumentedunilateralPA i e APAorUAH Fig 1 1QQOO Ifapatientisunableorunwillingtoundergosurgery werecommendmedicaltreatmentwithanMRantagonist Fig 1 1QQOO 4 2InpatientswithPAduetobilateraladrenaldisease werecommendmedicaltreatmentwithanMRantagonist 1QQOO wesuggestspironolactoneastheprimaryagentwitheplerenoneasanalternative Fig 1 2QOOO 4 3InpatientswithGRA werecommendtheuseofthelowestdoseofglucocorticoidthatcanno