110年:內專
A 50-year-old male visited outpatient clinic due to difficult-to-control hypertension. After initial work up, hypokalemic hypertensive disorder was impressed, Further laboratory evaluation of adrenal hormones including plasma renin, aldosterone, cortisol, and androgen levels were arranged to distinguish among specific diagnoses. The results are: high renin level, high aldosterone level, an aldosterone-to-renin ratio of 10 : 1 ; and a normal serum cortisol level Which is the most possible diagnosis?
AACTH-secreting tumor。
BBartter syndrome。
CLiddle syndrome。
DPrimary hyperaldosteronism。
EUnilateral renal artery stenosis。
詳細解析
本題觀念:
本題在於鑑別不同原因所致的低鉀性高血壓(hypokalemic hypertensive disorders),關鍵指標為血漿renin及aldosterone水準及其比例(ARR, aldosterone-to-renin ratio)。
- Primary hyperaldosteronism:腎上腺自主分泌過多aldosterone,造成renin抑制(低renin)、aldosterone升高,ARR通常>20:1 (ncbi.nlm.nih.gov)
- Secondary hyperaldosteronism:外在因素(如腎動脈狹窄)刺激renin分泌升高,進而引發aldosterone升高,ARR通常較低(如10:1左右) (ncbi.nlm.nih.gov, [en.wikipedia.org](https://en.wikipedia.org/wiki/Hyperaldosteronism?utm_source=chatgp
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