肾上腺有瘤子，就要切掉吗？
<h2 style="font-weight: bold;white-space: normal;line-height: 1.6em;"><br/></h2><p></p><section style="white-space: normal;"><p style="letter-spacing: 1px;line-height: 2em;"><span style="font-size: 16px;"> 近日，我院高血压科接诊了两位特殊的高血压患者。</span></p><section data-support="96编辑器" data-style-id="32939"><section style="text-align: center;"><section style="margin-left: 10px;width: 1px;height: 46px;background-color: rgb(29, 132, 255);transform: rotateZ(46deg);"><br/></section><section style="margin: -30px 3px;padding: 15px;background-color: rgb(238, 245, 255);color: rgb(255, 186, 0);letter-spacing: 2px;font-size: 18px;box-sizing: border-box;"><section></section></section><section style="margin-right: 10px;margin-left: auto;width: 1px;height: 46px;background-color: rgb(29, 132, 255);transform: rotateZ(46deg);"><br/></section></section></section><section data-mpa-template="t" mpa-from-tpl="t"><section mpa-from-tpl="t"><section mpa-from-tpl="t"><section mpa-from-tpl="t"><section data-support="96编辑器" data-style-id="31585"><section style="margin-top: 10px;margin-bottom: 10px;"><section style="margin-left: auto;width: 2em;"><br/></section><section style="margin-top: -30px;margin-right: 10px;padding: 14px;background-color: rgb(255, 251, 251);border-radius: 0px 20px 0px 0px;box-sizing: border-box;"><section style="line-height: 1.75em;letter-spacing: 2px;font-size: 15px;transform: rotateZ(0deg);"><p style="letter-spacing: 1px;line-height: 2.5em;"><strong><span style="font-size: 16px;color: rgb(255, 76, 65);"> 患者一</span></strong><span style="font-size: 16px;">：张女士（化名），63岁，因“发现血压高8年，头晕乏力1月”入院，入院后完善了RAAS系统检查，立位2小时后RAAS结果：醛固酮 331.74pg/ml 肾素浓度 4.67pg/ml 醛固酮/肾素浓度 71.04，随后我们给患者进行了确诊试验，结果支持原发性醛固酮增多症诊断，随后完善了肾上腺CT：左侧肾上腺结合部结节状等密度影，直径约14mm考虑腺瘤。为明确定位，我们建议患者进行AVS检查，结果支持左侧优势侧，CT形态学病灶侧和AVS优势侧结果一致性相符，患者下一步诊治方案建议左侧肾上腺切除。</span></p></section></section></section></section></section></section></section></section><section data-mpa-template="t" mpa-from-tpl="t"><section mpa-from-tpl="t"><section mpa-from-tpl="t"><section mpa-from-tpl="t"><section data-support="96编辑器" data-style-id="31585"><section style="margin-top: 10px;margin-bottom: 10px;"><section style="margin-left: auto;width: 2em;"><br/></section><section style="margin-top: -30px;margin-right: 10px;padding: 14px;background-color: rgb(255, 251, 251);border-radius: 0px 20px 0px 0px;box-sizing: border-box;"><section style="line-height: 1.75em;letter-spacing: 2px;font-size: 15px;transform: rotateZ(0deg);"><p style="letter-spacing: 1px;line-height: 2.5em;"><strong><span style="font-size: 16px;color: rgb(255, 76, 65);"> 患者二</span></strong><span style="font-size: 16px;">：刘女士（化名），60岁，因“发现血压高2天”入院，入院后查立位2小时RAAS结果：醛固酮 135.13 pg/ml 肾素浓度 1.35 pg/ml 醛固酮/肾素浓度 100.10，随后进行的确诊试验证实患者为原发性醛固酮增多症，同样我们按照原醛症诊治流程对患者进行了肾上腺CT及AVS检查，CT结果示：考虑左侧肾上腺增生，小腺瘤。AVS结果：右侧优势侧。CT形态学病灶侧和AVS结果不一致，下一步处理方案：遵AVS结果行右侧肾上腺切除术。</span></p></section></section></section></section></section></section></section></section><section data-support="96编辑器" data-style-id="32601"><section style="margin-top: 10px;margin-bottom: 10px;text-align: center;"><section style="display: inline-block;background-color: rgb(255, 0, 0);border-radius: 0px 30px;box-sizing: border-box;"><section style="padding: 3px 26px;letter-spacing: 2px;color: rgb(254, 254, 254);font-size: 16px;box-sizing: border-box;"><p><strong>什么是原发性醛固酮增多症？</strong><span style="letter-spacing: 1px;color: rgb(51, 51, 51);text-align: justify;"></span></p></section></section></section></section><section data-mpa-template="t" mpa-from-tpl="t"><section mpa-from-tpl="t"><section mpa-from-tpl="t"><section mpa-from-tpl="t"><section data-support="96编辑器" data-style-id="31585"><section style="margin-top: 10px;margin-bottom: 10px;"><section style="margin-left: auto;width: 2em;"><br/></section><section style="margin-top: -30px;margin-right: 10px;padding: 14px;background-color: rgb(255, 251, 251);border-radius: 0px 20px 0px 0px;box-sizing: border-box;"><section style="line-height: 1.75em;letter-spacing: 2px;font-size: 15px;transform: rotateZ(0deg);"><p style="letter-spacing: 1px;line-height: 2.5em;"><span style="font-size: 16px;"> 原发性醛固酮增多症简称原醛症，是由于肾上腺皮质自主分泌醛固酮，导致体内潴钠排钾，血容量增多，肾素-血管紧张素受抑制，呈现低肾素高醛固酮改变，临床主要表现为高血压和低血钾。原醛症是常见的继发性高血压的致病原因之一，2010年由中华医学会内分泌学分会牵头的在全国11个省19个中心对1656例难治性高血压患者进行原醛症的筛查，报道其患病率为7.1%，新近文献报道，在新诊断高血压中的发生率超过4%。</span></p><p style="letter-spacing: 1px;line-height: 2.5em;"><span style="font-size: 16px;"> 原醛症分6型，包括醛固酮瘤、特发性醛固酮增多症、原发性肾上腺皮质增生、家族性醛固酮增多症、分泌醛固酮的肾上腺皮质癌及异位醛固酮分泌瘤。</span></p></section></section></section></section></section></section></section></section><section data-support="96编辑器" data-style-id="32939"><section style="text-align: center;"><section style="margin-left: 10px;width: 1px;height: 46px;background-color: rgb(29, 132, 255);transform: rotateZ(46deg);"><br/></section><section style="margin: -30px 3px;padding: 15px;background-color: rgb(238, 245, 255);color: rgb(255, 186, 0);letter-spacing: 2px;font-size: 18px;box-sizing: border-box;"><section></section></section><section style="margin-right: 10px;margin-left: auto;width: 1px;height: 46px;background-color: rgb(29, 132, 255);transform: rotateZ(46deg);"><br/></section></section></section><section data-mpa-template="t" mpa-from-tpl="t"><section mpa-from-tpl="t"><section mpa-from-tpl="t"><section mpa-from-tpl="t"><section data-support="96编辑器" data-style-id="31585"><section style="margin-top: 10px;margin-bottom: 10px;"><section style="margin-left: auto;width: 2em;"><br/></section><section style="margin-top: -30px;margin-right: 10px;padding: 14px;background-color: rgb(255, 251, 251);border-radius: 0px 20px 0px 0px;box-sizing: border-box;"><section style="line-height: 1.75em;letter-spacing: 2px;font-size: 15px;transform: rotateZ(0deg);"><p style="letter-spacing: 1px;line-height: 2.5em;"><span style="font-size: 16px;"> </span><span style="font-size: 16px;color: rgb(255, 76, 65);">AVS（肾上腺静脉采血术）</span><span style="font-size: 16px;">是在数字减影血管造影（DSA）引导下进行的原醛症定位诊断的有创检查，是目前明确原发性醛固酮增多症优势侧的金标准，对CT提示有单侧或双侧肾上腺形态异常（包括增生或腺瘤），患者有手术意愿且手术可行的原醛症患者都建议行AVS明确优势侧指导后期手术部位。仅仅依赖CT检查通过形态学异常简单判断手术侧可能会导致如本文第二例患者那样切除了无功能腺瘤侧，而保留了致病侧，对患者后期的诊治带来很大的麻烦。</span></p><p style="letter-spacing: 1px;line-height: 2.5em;"><span style="font-size: 16px;"> </span><span style="font-size: 16px;color: rgb(255, 76, 65);">治疗方案</span><span style="font-size: 16px;">：原醛症患者AVS明确有优势侧，手术切除患侧肾上腺是原醛症患者的首选治疗方案，对无优势侧或不具备手术条件或拒绝手术患者，口服醛固酮受体拮抗剂如螺内酯等是药物治疗的首选，依普利酮因为其不干扰孕激素、雄激素的优势但因价格昂贵及获取难得而作为二线用药。</span><span style="font-size: 16px;"></span></p></section></section></section></section></section></section></section></section><section data-support="96编辑器" data-style-id="32939"><section style="text-align: center;"><section style="margin-left: 10px;width: 1px;height: 46px;background-color: rgb(29, 132, 255);transform: rotateZ(46deg);"><br/></section><section style="margin: -30px 3px;padding: 15px;background-color: rgb(238, 245, 255);color: rgb(255, 186, 0);letter-spacing: 2px;font-size: 18px;box-sizing: border-box;"><section></section></section><section style="margin-right: 10px;margin-left: auto;width: 1px;height: 46px;background-color: rgb(29, 132, 255);transform: rotateZ(46deg);"><br/></section></section></section><section data-support="96编辑器" data-style-id="32600"><section style="margin-top: 10px;margin-bottom: 10px;text-align: center;"><section style="display: inline-block;background-color: rgb(255, 0, 0);border-radius: 30px 0px;box-sizing: border-box;"><section style="padding: 3px 26px;letter-spacing: 2px;color: rgb(254, 254, 254);font-size: 16px;box-sizing: border-box;"><p><strong>那么哪些病人需要进行原醛症的筛查呢？</strong></p></section></section></section></section><section data-mpa-template="t" mpa-from-tpl="t"><section mpa-from-tpl="t"><section mpa-from-tpl="t"><section mpa-from-tpl="t"><section data-support="96编辑器" data-style-id="31585"><section style="margin-top: 10px;margin-bottom: 10px;"><section style="margin-left: auto;width: 2em;"><br/></section><section style="margin-top: -30px;margin-right: 10px;padding: 14px;background-color: rgb(255, 251, 251);border-radius: 0px 20px 0px 0px;box-sizing: border-box;"><section style="line-height: 1.75em;letter-spacing: 2px;font-size: 15px;transform: rotateZ(0deg);"><p style="letter-spacing: 1px;line-height: 2.5em;"><span style="font-size: 16px;"> 中华医学会内分泌学会发布的《原发性醛固酮增多症诊断治疗的专家共识（2020版）》对筛查人群作了明确规定：</span></p><p style="letter-spacing: 1px;line-height: 2.5em;"><span style="font-size: 16px;">1. 持续性高血压（＞150/100mmHg）者、难治性高血压及新诊断高血压患者。</span></p><p style="letter-spacing: 1px;line-height: 2.5em;"><span style="font-size: 16px;">2. 高血压合并自发性或利尿剂所致的低钾血症的患者。</span></p><p style="letter-spacing: 1px;line-height: 2.5em;"><span style="font-size: 16px;">3. 高血压合并肾上腺意外瘤的患者。</span></p><p style="letter-spacing: 1px;line-height: 2.5em;"><span style="font-size: 16px;">4. 早发性高血压家族史或早发（＜40岁）脑血管意外家族史的高血压患者。</span></p><p style="letter-spacing: 1px;line-height: 2.5em;"><span style="font-size: 16px;">5. 原醛症患者中存在高血压一级亲属。</span></p><p style="letter-spacing: 1px;line-height: 2.5em;"><span style="font-size: 16px;">6. 高血压合并阻塞性睡眠呼吸暂停的患者。</span></p></section></section></section></section></section></section></section></section></section><p></p><p style="white-space: normal;font-family: -apple-system, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif;letter-spacing: 1px;line-height: 2em;"></p><p></p><section style="white-space: normal;font-family: -apple-system, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif;letter-spacing: 0.544px;"><section><section style="margin-top: 10px;margin-bottom: 10px;"><section style="padding-left: 11px;display: inline-block;width: 676.994px;vertical-align: top;box-sizing: border-box;"><section><section style="display: inline-block;width: 665.997px;vertical-align: top;background-color: rgba(255, 255, 255, 0);border-style: solid;border-width: 1px;border-radius: 0px;border-color: rgb(7, 48, 196);box-sizing: border-box;"><section><section style="margin-top: 10px;display: flex;flex-flow: row nowrap;text-align: left;justify-content: flex-start;transform: translate3d(-8px, 0px, 0px);"><section style="display: inline-block;vertical-align: top;width: auto;line-height: 0;letter-spacing: 0px;flex: 0 0 0%;height: auto;align-self: flex-start;"><section style="text-align: right;justify-content: flex-end;"><section style="display: inline-block;width: 8px;height: 45px;vertical-align: top;overflow: hidden;"><section style="text-align: center;"><section style="vertical-align: middle;display: inline-block;line-height: 0;width: 7.8267px;height: auto;"><svg xmlns="http://www.w3.org/2000/svg" x="0px" y="0px" viewbox="0 0 1.5 8.7" style="vertical-align: middle;width: 100%;" width="100%" data-width="100%"><g><path d="M1.5,0.2C0.8,0.2,0.2,0.6,0.2,1v6.2C0.5,6.9,1,6.8,1.5,6.8V0.2z" fill="rgb(255,255,255)"></path></g><g><path d="M0.2,7.7H0V1c0-0.5,0.7-1,1.5-1v0.2C0.8,0.2,0.2,0.6,0.2,1v6.2C0.5,6.9,1,6.8,1.5,6.8V7C0.8,7,0.2,7.3,0.2,7.7 z" fill="rgb(7,48,196)"></path></g><g><path d="M1.5,8.7C0.7,8.7,0,8.3,0,7.7s0.7-0.9,1.5-0.9V7C0.8,7,0.2,7.3,0.2,7.7s0.6,0.7,1.3,0.7V8.7z" fill="rgb(7,48,196)"></path></g><g><path d="M1.5,7C0.8,7,0.2,7.3,0.2,7.7s0.6,0.7,1.3,0.7V7z" fill="#5f9cef"></path></g></svg></section></section></section></section></section><section style="margin-left: -1px;display: inline-block;vertical-align: top;width: auto;flex: 100 100 0%;align-self: flex-start;height: auto;"><section style="justify-content: flex-start;"><section style="padding-right: 20px;padding-left: 10px;display: inline-block;vertical-align: top;overflow: hidden;height: 36px;width: auto;min-width: 10%;border-width: 1px;border-bottom-right-radius: 100px;border-style: solid solid solid none;border-color: rgb(7, 48, 196) rgb(7, 48, 196) rgb(7, 48, 196) rgb(138, 50, 222);border-top-right-radius: 100px;border-bottom-left-radius: 0px;box-sizing: border-box;"><section style="color: rgb(7, 48, 196);text-align: center;letter-spacing: 2px;line-height: 2.2;"><p><strong>联系方式</strong></p></section></section></section></section></section></section><section style="margin-bottom: 10px;"><section style="padding-right: 20px;padding-left: 20px;color: rgb(62, 62, 62);letter-spacing: 1.8px;line-height: 1.8;box-sizing: border-box;"><section style="line-height: 2em;">1、咨询株洲恺德心血管病医院订阅号<strong><span style="color: rgb(7, 48, 196);">在线客服；</span></strong><br data-filtered="filtered"/>2、咨询电话：<strong><span style="color: rgb(7, 48, 196);">0731-28260137</span></strong></section><section style="line-height: 2em;">3、联系地址：株洲恺德心血管病医院<span style="color: rgb(7, 48, 196);"><strong>第二住院大楼3楼（心血管内三科）</strong></span></section></section></section></section></section></section></section></section><section><section style="letter-spacing: 0.544px;text-align: right;font-size: 12px;"><section style="margin-top: 10px;margin-bottom: 10px;font-size: 16px;letter-spacing: 0.544px;"><section style="border-top: 1px solid rgb(7, 48, 196);line-height: 0;box-sizing: border-box;"><section data-filtered="filtered" style="line-height: 0;width: 0px;"><svg viewbox="0 0 1 1" style="vertical-align:top;"></svg></section></section><section style="margin-top: 3px;border-top: 4px solid rgb(7, 48, 196);line-height: 0;box-sizing: border-box;"><section data-filtered="filtered" style="line-height: 0;width: 0px;"><svg viewbox="0 0 1 1" style="vertical-align:top;"></svg></section></section></section><section style="letter-spacing: 0.544px;"><p><span style="letter-spacing: 0.544px;">文案：刘平平</span><span style="letter-spacing: 0.544px;font-size: 17px;text-align: justify;"></span></p></section></section></section></section><p></p><h2 style="font-weight: bold;white-space: normal;line-height: 1.6em;"><br/></h2><p><br/></p><link rel="stylesheet" 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