摘要
目的 探讨肾上腺皮髓质混合性病变 (醛固酮 儿茶酚胺症 )的临床特点和诊治方法。 方法 回顾分析 4例肾上腺皮髓质混合性病变资料。 结果 4例均有高血压、低血钾和高醛固酮血症 ,2例分别伴有高代谢和高血糖症 ,血浆肾素、血管紧张素活性正常或略增高 ,尿儿茶酚胺及其代谢产物水平正常。经B超、CT或MRI诊断为肾上腺肿瘤 ,行患侧肾上腺切除术 ,术后血钾、血糖恢复正常 ,高血压消失或明显缓解。病理诊断为肾上腺皮质增生或腺瘤伴髓质增生或嗜铬细胞瘤。 结论 肾上腺皮髓质混合性病变均有原醛症表现 ,部分病例同时有儿茶酚胺症的特点 ,综合分析临床资料可能在术前作出诊断 ,围手术期应按儿茶酚胺症处理 。
Objective To study the clinical features,diagnostic and treatment of coexisting primary aldosteronism and pheochromocytoma. Methods The clinical data of 4 cases of coexisting primary aldosteronism and pheochromocytoma were retrospectively analyzed. Results The ocurrence of coexisting primary aldosteronism and pheochromocytoma was 2.8% of the primary aldosteroniam. All the 4 cases had hypertension ,hypokalemia or hyperaldosteronism, and 2 of them had hypermetabolism and hyperglycemia.The plasma renin and angiotensin Ⅱactivity were normal or slightly increased, and urinary catecholamine and its metabolites were in normal range.The adrenal tumor were revealed on ultrasonography, CT scan and MRI, 3 being at the left side and 1 at the right side. The size of the tumors was 1.0 to 7.5cm in diameter. Resection of the involved adrenal gland was performed in all the patients. After operation, the plasma potassium and the glucose level became normal with hypertension disappeared or significantly relieved. Histopathological studies revealed the coexistence of adrenal cortical hyperplasia (or adenoma) and medullary hyperplasia or pheochromocytoma. Conclusions Manifestations of aldosteronism can be seen in all and features of pheochromocytoma can be found in some of the cases.Preoperative diagnosis may be assesed if the clinical data is comprehensively analyzed.Perioperative management should be the same as in pheochromocytoma.The final diagnosis dependents on histopathological studies.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2000年第10期587-589,共3页
Chinese Journal of Urology
