A Clinical Feature Analysis Of Primary Aldosteronism

Primary aldosteronism may be the most common form of secondary hypertension, its clinical manifestation includs hypertension, hypokalemia, elvated plasma and urinary aldosterone , and low plasma renin activity. Most of primary aldosteronism is easily misdiagnosd in clinic, which is failed to hypotensive drug treatment, and easily appears to increase cardiovascular or ecerebrovascular complications. Therefore early discovery, early treatment should ameliorate the prognosis of primary aldosteronism. But the diagnosis of primary aldosteronism is tedious. It is hard to discriminate between aldosteronism aldosterone-producing adenoma ( APA) which adenoma is less than 0.5cm and idiopathic aldosteronism (IHA) , as well as some untypical primary aldosteronism are difficultily diagnosised. So the dignosis of primary aldosteronism may be base on its clinical features, laboratory inspection and CT iimaging. This article is to study the typical and untypical of primary aldosteronism(include its subtype), understand its various clinical features, and make us to pay more attention to primary aldosteronism. It may offer some help to the diagnosis of primary aldosteronism.MethodsFirst, the data of the clinical manifestation, auxiliary examination and therapy which 61 patients were diagnosed as primary aldosteronism were collected. Second, 61 patients were divided into two groups ( APA group and IHA group) . In last, the age, gender, the course of disease, blood pressure, serum potassium, 24 hour urine potassium, aldosterone in erect position and decubitus position of 61 patients were compared in two groups. Furthermore, the relation between the course of disease and heart abnormality in these groups was analysised.ResultsMost patients had sympotoms of hypertension and hypokalemic, but 1 patient blood pressure had always been normal. There were 53 patients with hypertension as initial symptom, 4 patients with hypokalemia as initial symptom, and 4 patients with hypertension and hypokalemia appeared in the meantime. Moreover, there were some cardiovascular and cerebrovascular complications such as cardiac enlargement (21 patients) , abnomal electrocardiogram of ST-T change (19 patients) , ventricular hypertrophy (21 patients) , bearing premature and conduction block (10 patients) , cerebral hemorrhage (1 patient) and cerbral infarction (1 patient), diabetes mellitus(5 patients) , impaired glucose tolerance (1 patient) . The plasma aldosterone of APA group had higher than IHA group in decumbent position (P<0.05), but two groups were no significant difference in age, blood pressure, serum potassium, 24 hour urine potassium, the course of disease, and aldosterone of erect position. The incidence rate of heart abnormality was little more than 50 percent in APA group which the course of disease was within 5 years, less than 50 percent which the course of disease was within 5 to 10 years, and near 90 percent which the course of disease was above 10 years. Though heart abnormality was not found in IHA group which the course of disease was within 5 years, the incidence rate of heart abnormality was 50 percent which the course of disease was within 5 to 10 years, and 100 percent which the course of disease was above 10 years. The incidence rate of heart abnormality in APA group was more than in IHA group which the course of disease was within 5 years (P<0.05). In contrast, the incidence rate of heart abnormality in APA group was less than in IHA group which the course of disease was above 10 years (P<0.05). There were no significant difference in two groups which the course of disease was within 5 to 10 years.Conclusion1. The clinical features of primary aldosteronism are variable.2. Some untypical clinical features of primary aldosteronism existed in clinic, we should pay more attention to it.