原发性醛固酮增多症的诊断和治疗进展课件

CaseDetection,Diagnosis,andTreatmentofPatientswithPrimaryAldosteronism:

AnEndocrineSocietyClinicalPracticeGuideline

原发性醛固酮增多症的病例检测、诊断和治疗：内分泌学会临床实践指南------JClinEndocrinolMetab，2008，93〔9〕：3266－3281．CaseDetection,Diagnosis,and1几个问题PA发病率及临床意义：<1%→>10%

更高的心脑血管疾病发病率及死亡率；特异性治疗可改善预后PA中低钾血症的发生率ARR测定方法及截点确定PA确诊试验与分型诊断几个问题2病例筛查Casedetection高发人群1|⊕⊕OOPA一级亲属合并高血压者1|⊕OOO筛查方法ARR1|⊕⊕OO确诊试验Caseconfirmation4个确诊试验之一即可1|⊕⊕OO亚型分类及定位Subtypeclassification肾上腺CT1|⊕⊕OO肾上腺静脉采血1|⊕⊕⊕O基因测定1|⊕⊕OO治疗Treatment单侧腹腔镜1|⊕⊕OO双侧或不能手术用MR拮抗剂1|⊕⊕OO螺内酯首选Eplerenone备选2|⊕OOOGRA小剂量糖皮质激素1|⊕OOO病例筛查Casedetection31.0CaseDetection1.1WerecommendthecasedetectionofPAinpatientgroupswithrelativelyhighprevalenceofPA(listedinTable1)(Fig.1).1.0CaseDetection4原发性醛固酮增多症的诊断和治疗进展课件5原发性醛固酮增多症的诊断和治疗进展课件6原发性醛固酮增多症的诊断和治疗进展课件7原发性醛固酮增多症的诊断和治疗进展课件8原发性醛固酮增多症的诊断和治疗进展课件9原发性醛固酮增多症的诊断和治疗进展课件10原发性醛固酮增多症的诊断和治疗进展课件11原发性醛固酮增多症的诊断和治疗进展课件122.0CaseConfirmation2.1Insteadofproceedingdirectlytosubtypeclassification,werecommendthatpatientswithapositivealdosterone-reninratio(ARR)measurementundergotesting,byanyoffourconfirmatorytests,todefinitivelyconfirmorexcludethediagnosis(Fig.1).(1QQOO)2.0CaseConfirmation13原发性醛固酮增多症的诊断和治疗进展课件14原发性醛固酮增多症的诊断和治疗进展课件15原发性醛固酮增多症的诊断和治疗进展课件16原发性醛固酮增多症的诊断和治疗进展课件173.0SubtypeClassification3.1WerecommendthatallpatientswithPAundergoanadrenalCTscanastheinitialstudyinsubtypetestingandtoexcludelargemassesthatmayrepresentadrenocorticalcarcinoma(Fig.1).(1QQOO)3.0SubtypeClassification183.2Werecommendthat,whensurgicaltreatmentispracticableanddesiredbythepatient,thedistinctionbetweenunilateralandbilateraladrenaldiseasebemadebyAVSbyanexperiencedradiologist(Fig.1).(1QQQO)3.2Werecommendthat,whensu193.3InpatientswithonsetofconfirmedPAearlierthanat20yrofageandinthosewhohaveafamilyhistoryofPAorofstrokesatyoungage,wesuggestgenetictestingforGRA(Fig.1).(2QOOO)3.3Inpatientswithonsetof204.0Treatment4.1WerecommendthatunilaterallaparoscopicadrenalectomybeofferedtopatientswithdocumentedunilateralPA(i.e.APAorUAH)(Fig.1).(1QQOO)Ifapatientisunableorunwillingtoundergosurgery,werecommendmedicaltreatmentwithanMRantagonist(Fig.1).(1QQOO)4.0Treatment214.2InpatientswithPAduetobilateraladrenaldisease,werecommendmedicaltreatmentwithanMRantagonist(1QQOO);wesuggestspironolactoneastheprimaryagentwitheplerenoneasanalternative(Fig.1).(2QOOO)4.2InpatientswithPAdueto224.3InpatientswithGRA,werecommendtheuseofthelowestdoseofglucocorticoidthatcannormalizebloodpressureandpotassiumlevelsratherthanfirst-linetreatmentwithanMRantagonist(Fig.1).(1QOOO)4.3InpatientswithGRA,werec23CaseDetection,Diagnosis,andTreatmentofPatientswithPrimaryAldosteronism:

AnEndocrineSocietyClinicalPracticeGuideline

原发性醛固酮增多症的病例检测、诊断和治疗：内分泌学会临床实践指南------JClinEndocrinolMetab，2008，93〔9〕：3266－3281．CaseDetection,Diagnosis,and24几个问题PA发病率及临床意义：<1%→>10%

更高的心脑血管疾病发病率及死亡率；特异性治疗可改善预后PA中低钾血症的发生率ARR测定方法及截点确定PA确诊试验与分型诊断几个问题25病例筛查Casedetection高发人群1|⊕⊕OOPA一级亲属合并高血压者1|⊕OOO筛查方法ARR1|⊕⊕OO确诊试验Caseconfirmation4个确诊试验之一即可1|⊕⊕OO亚型分类及定位Subtypeclassification肾上腺CT1|⊕⊕OO肾上腺静脉采血1|⊕⊕⊕O基因测定1|⊕⊕OO治疗Treatment单侧腹腔镜1|⊕⊕OO双侧或不能手术用MR拮抗剂1|⊕⊕OO螺内酯首选Eplerenone备选2|⊕OOOGRA小剂量糖皮质激素1|⊕OOO病例筛查Casedetection261.0CaseDetection1.1WerecommendthecasedetectionofPAinpatientgroupswithrelativelyhighprevalenceofPA(listedinTable1)(Fig.1).1.0CaseDetection27原发性醛固酮增多症的诊断和治疗进展课件28原发性醛固酮增多症的诊断和治疗进展课件29原发性醛固酮增多症的诊断和治疗进展课件30原发性醛固酮增多症的诊断和治疗进展课件31原发性醛固酮增多症的诊断和治疗进展课件32原发性醛固酮增多症的诊断和治疗进展课件33原发性醛固酮增多症的诊断和治疗进展课件34原发性醛固酮增多症的诊断和治疗进展课件352.0CaseConfirmation2.1Insteadofproceedingdirectlytosubtypeclassification,werecommendthatpatientswithapositivealdosterone-reninratio(ARR)measurementundergotesting,byanyoffourconfirmatorytests,todefinitivelyconfirmorexcludethediagnosis(Fig.1).(1QQOO)2.0CaseConfirmation36原发性醛固酮增多症的诊断和治疗进展课件37原发性醛固酮增多症的诊断和治疗进展课件38原发性醛固酮增多症的诊断和治疗进展课件39原发性醛固酮增多症的诊断和治疗进展课件403.0SubtypeClassification3.1WerecommendthatallpatientswithPAundergoanadrenalCTscanastheinitialstudyinsubtypetestingandtoexcludelargemassesthatmayrepresentadrenocorticalcarcinoma(Fig.1).(1QQOO)3.0SubtypeClassification413.2Werecommendthat,whensurgicaltreatmentispracticableanddesiredbythepatient,thedistinctionbetweenunilateralandbilateraladrenaldiseasebemadebyAVSbyanexperiencedradiologist(Fig.1).(1QQQO)3.2Werecommendthat,whensu423.3InpatientswithonsetofconfirmedPAearlierthanat20yrofageandinthosewhohaveafamilyhistoryofPAorofstrokesatyoungage,wesuggestgenetictestingforGRA(Fig.1).(2QOOO)3.3Inpatientswithonsetof434.0Treatment4.1WerecommendthatunilaterallaparoscopicadrenalectomybeofferedtopatientswithdocumentedunilateralPA(i.e.APAorUAH)(Fig.1).(1QQOO)Ifapatientisunableorunwillingtoundergosurgery,werecommendmedicaltreatmentwithanMRantagonist(Fig.1).(1QQOO)4.0Treatment444.2InpatientswithPAduetobilateraladrenaldisease,werecommendmedicaltreatmentwithanMRantagonist(1QQOO);wesuggestspironolactoneastheprimaryagentwitheplerenoneasanalternative