• Journal of Medicine and Life Science
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• 제17권2호
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• pp.60-63
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• 2020

Primary aldosteronism has been found more often among patients with hypertension. Primary aldosteronism can be caused by an aldosterone-producing adenoma, bilateral adrenal hyperplasia, or rarely by an adrenal carcinoma. An initial diagnostic test for aldosteronism is a measurement of the plasma renin activity and aldosterone concentration. For example, up to 20% of patients with hypertension showed increased plasma aldosterone concentration/renin activity ratio. If surgery is planned, an adrenal vein sampling is necessary for exact localization. Spironolactone, an aldosterone antagonist, is the drug of choice for patients with an aldosterone-producing adenoma or hyperplasia. It can control elevated blood pressure in most primary aldosteronism patients. However, unilateral laparoscopic adrenalectomy is the best treatment for aldosterone-producing adenoma or asymmetrical aldosterone production in patients with uncontrolled hypertension. Here we report a patient with primary aldosteronism caused by unilateral adrenal hyperplasia and a contralateral adrenal adenoma who required as many as five different kinds of antihypertensive medications for controlling elevated blood pressure. The adrenal adenoma was successfully removed by unilateral adrenalectomy and the blood pressure had been controlled well after the surgery.

• 사상체질의학회지
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• 제20권2호
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• pp.111-118
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• 2008

1. Objective Primary aldosteronism is clinically characterized by hypertension and hypokalemia. The purpose of this article is to report our case about a female patient with suspected primary aldosteronism. 2. Methods We diagnosed her as Soyangin Heat Sensation in chest and treated with Yangkyuksanhwa-rang and Hyungbangjihwang-tang. And potassium replacement therapy was applied to correct hypokalemia. 3. Results and Conclusions In this case, through Herb-medication, most symptoms were improved except dry mouth, Bur hypokalemia was not corrected, and primary aldosteronism was suspected on the basis of the blood results and symptoms.

• Annals of Clinical Neurophysiology
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• 제18권1호
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• pp.21-24
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• 2016

Primary aldosteronism is one of the most common cause of secondary hypertension and can be accompanied with hypokalemia. Rhabdomyolysis with hypokalemia in primary aldosteronism has been rarely reported. We describe a patient of primary aldosteronism who presented with limb-girdle type weakness.

• 대한한방내과학회지
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• 제20권1호
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• pp.280-285
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• 1999

We report 1 patient with Primary aldosteronism caused by malfunction of adrenal gland. which occupies 1-2% of the whole Hypertensive disease. The patient was 35 year-old female with the history of hypertension. She was hospitalized at Department of Circulatory Internal Medicine. College of Oriental Medicine, Kyung Hee University, Seoul, because of low limb weakness, chest discomport, palpitation and dry mouth. The value of serum potassium level was o.6 and at last adenoma was diagnosed on the basis of abdomen CT scan. The Primary aldosteronism manifests myasthenia, headache, dry mouth, palpitation. In laboratory findings, it especially shows specific U -wave in EKG due to low serum potassium level resulted from excessive flow-out through urine. It could be regarded as ‘Flaccid paralysis of Limbs(?症)‘, the Oriental medical term which indicates a condition of general weakness. We report on this case with a review of literature.

• Journal of Yeungnam Medical Science
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• 제29권2호
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• pp.113-117
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• 2012

Primary aldosteronism is characterized by hypertension, hypokalemia, and metabolic alkalosis, associated with excessive aldosterone production and suppressed plasma renin activity. Hypokalemia-induced rhabdomyolysis has been rarely reported in primary aldosteronism patients. This paper reports a case of primary aldosteronism presented with rhabdomyolysis due to severe hypokalemia. A 48-year-old male with a three-year history of hypertension presented himself at the authors' hospital with generalized weakness and myalgia in both legs over a period of several days. His laboratory findings showed hypokalemia (1.8 mEq/L) with elevations of his serum creatine phosphokinase and serum myoglobin. His plasma aldosterone level was also elevated, and his plasma renin activity was reduced. An abdominal computed tomography revealed a 2.0 cm hypodense mass in the left adrenal gland, which suggested adrenal adenoma. The accordingly underwent laparoscopic adrenalectomy. Three months later, his plasma potassium level and blood pressure became normal without the use of medications.

• Endocrinology and Metabolism
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• 제33권4호
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• pp.429-434
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• 2018

As diagnostic techniques have advanced, primary aldosteronism (PA) has emerged as the most common cause of secondary hypertension. The excess of aldosterone caused by PA resulted in not only cardiovascular complications, including coronary artery disease, myocardial infarction, arrhythmia, and heart failure, but also cerebrovascular complications, such as stroke and transient ischemic attack. Moreover, PA is associated more closely with these conditions than is essential hypertension. In this review, we present up-to-date findings on the association between PA and cerebrovascular diseases.

• 핵의학기술
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• 제12권3호
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• pp.241-246
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• 2008

목적 : 고혈압은 뚜렷한 원인을 찾을 수 없는 본태성고혈압과 다른 원인에 의한 이차성 고혈압으로 크게 나눌 수 있다. 이차성 고혈압은 원인 질환을 알고 치료하면 치유가 가능한 고혈압으로써 고혈압 환자 중에서 비교적 흔히 발생되는 것으로 보고되고 있다. 본 연구는 임상에서 원발성 알도스테론증으로 진단된 이차성고혈압 환자군이 알도스테론/레닌의 비율을 산출하였을 때 이 비율이 정상군보다 얼마나 비정상적으로 증가되어 있는지 또한 본태성고혈압 환자군과는 얼마나 차이가 있는지를 알아보고자 한다. 실험재료 및 방법 : 2006년 4월부터 2008년 3월까지 분당 서울대병원에 내원하여 알도스테론과 레닌활성도를 검사한 환자들(n=901)을 대상으로 하였다. 크게 3그룹으로 분류하여 정상군(n=147), 본태성 고혈압환자군(n=709), 원발성 알도스테론증 환자군(n=45)에 대한 알도스테론, 레닌, 알도스테론/레닌의 비율에 대한 평균${\pm}$표준편차를 측정하였고, 각 그룹간 비교분석에서 유의확률(p-value)값을 구하였다. ROC 곡선을 이용하여 알도스테론/레닌 비율의 기준치(Cut off)에 따른 민감도와 특이도를 구하였다. 결과 : 각 그룹간 알도스테론, 레닌, 알도스테론/레닌 비율의 평균${\pm}$표준편차를 비교하여 보았을 때 정상군(n=147)에서는 알도스테론 : $87.40{\pm}52.81$, 레닌 : $3.16{\pm}5.35$, 알도스테론/레닌 비율 : $52.88{\pm}52.46$로 측정되었고, 본태성 고혈압환자군(n=709)에서는 알도스테론 : $132.39{\pm}83.59$, 레닌 : $2.71{\pm}3.37$, 알도스테론/레닌 비율 : $171.04{\pm}291.56$로 측정되었고, 원발성 알도스테론증으로 진단받은 환자군(n=45)에서는 알도스테론 : $342.48{\pm}229.30$, 레닌 : $0.24{\pm}0.29$, 알도스테론/레닌 비율 : $2325.74{\pm}2200.88$로써 상당히 높게 측정되었다. 알도스테론/레닌 비율의 그룹 간 비교에서는 원발성 알도스테론증의 환자 그룹과 정상그룹, 본태성 고혈압환자그룹 사이에서 p<0.001로써 각각 유의한 차이가 있음을 보였고, 원발성 알도스테론증을 선별함에 있어 ROC 곡선상에서 알도스테론/레닌 비율의 기준치는 Cut off : 485일 때 민감도 : 91.1%, 특이도 : 92.4%를 보였다. 결론 : 아직 표준화된 알도스테론/레닌 비율의 기준치가 정립화 되어 있는 것은 아니지만 본 연구를 통해서 원발성 알도스테론증 환자군은 정상군에 비해서 알도스테론/레닌의 비율이 상당히 높게 증가된다는 것을 알 수 있었고 이는 부신선종(adenoma)으로 인해 알도스테론이 만성적으로 과잉 분비되어 억제된 레닌 활성도를 보이는 것을 의미하고 있다. 즉 알도스테론/레닌 비율의 검사는 임상에서 원발성 알도스테론증을 진단함에 있어 임상적으로 유용하게 사용될 수 있을 거라 생각되어진다.

• Endocrinology and Metabolism
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• 제33권4호
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• pp.485-492
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• 2018

Background: Increasing evidence supports interplay between aldosterone and parathyroid hormone (PTH), which may aggravate cardiovascular complications in various heart diseases. Negative structural cardiovascular remodeling by primary aldosteronism (PA) is also suspected to be associated with changes in calcium levels. However, to date, few clinical studies have examined how changes in calcium and PTH levels influence cardiovascular outcomes in PA patients. Therefore, we investigated the impact of altered calcium homeostasis caused by excessive aldosterone on cardiovascular parameters in patients with PA. Methods: Forty-two patients (mean age $48.8{\pm}10.9$ years; 1:1, male:female) whose plasma aldosterone concentration/plasma renin activity ratio was more than 30 were selected among those who had visited Severance Hospital from 2010 to 2014. All patients underwent adrenal venous sampling with complete access to both adrenal veins. Results: The prevalence of unilateral adrenal adenoma (54.8%) was similar to that of bilateral adrenal hyperplasia. Mean serum corrected calcium level was $8.9{\pm}0.3mg/dL$ (range, 8.3 to 9.9). The corrected calcium level had a negative linear correlation with left ventricular end-diastolic diameter (LVEDD, ${\rho}=-0.424$, P=0.031). Moreover, multivariable regression analysis showed that the corrected calcium level was marginally associated with the LVEDD and corrected QT (QTc) interval (${\beta}=-0.366$, P=0.068 and ${\beta}=-0.252$, P=0.070, respectively). Conclusion: Aldosterone-mediated hypercalciuria and subsequent hypocalcemia may be partly involved in the development of cardiac remodeling as well as a prolonged QTc interval, in subjects with PA, thereby triggering deleterious effects on target organs additively.

• 대한영상의학회지
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• 제85권2호
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• pp.456-462
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• 2024

원발성 알도스테론증은 자율신경계에 의한 알도스테론 분비조절의 장애로 고혈압 및 저칼륨혈증과 관련이 있다. 원발성 알도스테론증에서 편측성을 결정하는 것이 매우 중요한 이유는 그에 따라 치료 방법이 달라지기 때문이다. 부신정맥채혈술은 원발성 알도스테론증에서 편측성을 평가하는 가장 신뢰성 있는 방법으로 알려져 있다. 부신정맥채혈술은 부신 정맥이 크기가 매우 작으며 그 해부학적 위치가 다양하기 때문에 기술적으로 어려운 시술이다. 따라서 성공적인 시술을 위해서는 해부학적 변이를 잘 이해하고 시술 전 영상 검사를 면밀히 검토하는 것이 중요하다. 부신정맥채혈술 중에 발견된 세 가지 해부학적 변이를 보고하고자 한다.

• 대한영상의학회지
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• 제84권2호
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• pp.386-397
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• 2023

일차성고알도스테론혈증은 고혈압의 원인 중 높은 비중을 차지하는 질병이다. 부신정맥채혈술은 일차성고알도스테론혈증의 원인을 감별하여 최종적인 치료방침을 결정하는 데 있어 필수적인 검사이다. 부신정맥채혈술의 성공 여부는 각 부신정맥에서 채혈한 샘플의 혈중 코티솔 농도와 말초혈관에서 채혈한 샘플의 혈중 코티솔 농도의 비를 측정하여 판단한다. 하대정맥으로 바로 연결되는 오른부신정맥에서 시술의 실패율이 더 높게 보고되며 상대적으로 왼부신정맥의 시술 실패율은 낮지만 드물게 보고된다. 본 임상화보에서는 왼부신정맥 부신정맥채혈술의 실패 사례를 소개하고 분석하여 최적의 부신정맥채혈술을 위한 고려사항에 대해 고찰하고자 한다.