2译esavs final醛固酮增多症

Dr.AstridWehner,Dipl.ECVIM-ESAVS,FelineMedicineandSurgery4–EndocrinologyandReproductionShanghai,Sept.22nd–26th,2014DSH,13yearsm/nindoorwithaccesstohasnotbeenvaccinatedordewormedrecentlyHistorycaeseveralhasdevelopedacuteweakness3daysPhysicalexamLethargicheart:160 心率160abdominalpalpation:possiblemasseffectmid-abdomen,approx.1x1cm Problemlistanemia,↓glucose,↓potassium,↓↑calcium,systemicdiseasepain,feverDDs„abdominalmass腹部肿块 Congestionrightheartfaliure,torsionInfiltrationtumor, tion,fatandglycogenforeignbodyReference0.97-2.36100-124146-1653.5-5.6Calcium1.1-1.357.34-36-4019-24Reference0-630-1140-940-4,740-41457-9426-565-11,30-1693,7-6,9Reference5-10x5,6-9,30,3-0,44180-550x6-18x0-0,5x1-4x00-0,6x3-11x0-0,6xRightRightadrenalGeneralizedparesis,typelowermotorNewproblemlistparesis,type„lowermotorelevatedDDs„hypokalemia低钾血症intracellularshiftinsulinexchang-ewithprotonsH+(alkalosis,adn-

of )与氢离子交换（碱毒症，注入 LossGI(Vomiting,消化道（，拉稀KidneysCKDhyperthyroidsm,hyperaldosteronismpostobstructivediuresis甲亢，高醛固酮症，去梗阻后利尿DDsCK肌酸激酶damagetomusclecellsSkeletalTraumaMyositisCramps,seizures肌肉，癫HeartMyocarditisInfarctDDs„adrenalmass肾上腺肿块metastasis,hemorrhage,MedullaCortexGlucocorticoidsAldosteronehormonesParesis轻度↑CK↑cause:aldosteroneprod.adrenaladrenalmassproductive:prod.NextdiagnosticbloodpressuremeasurementBloodpressure280mmHgsyst.(averageof5DefinitionofhypertensionwhitecoateffectCatskidneydiabetes01000Cats0100罕见0IRISsubstageriskoftargetorgandamage(mmHg)(mmEvidenceofTODTOD的KidneyprogressionofCKDEyeBrainEvidenceofvesselsandheartcardiacfailureEpistaxisIndicationsforevaluating ialsignsassociatedwithhypertensiveTODdiseasesassociatedwithReference40-195EffectsofaldosteroneHypertensionNaretentionNabloodvolumePolymyopathyKexcretionKmetabolicalkalosisRemodelingcardiacfibrosis Aldosteronerenin肾素cause:adrenalhypersia,adrenalcarcinomaor–adenomaAldosterone↑:activationofcause:cong.heartfailure,renaldx,liverfailurePrim. sia l ladenomacarcinoma腺瘤，equal sia l, l?)双侧，（单侧Prim.signalment:oldercats,median13clinic:weakness,ventroflexion,PU/PD,anorexia,weightloss,ataxia,blindnessecho:adrenalmassoradrenal polyendocrinopathiesLaboratorypotassiummild–moderate↓钾离子轻度 sodiumnormal(mild钠离子正常（轻度升高dilutionduetowaterretentionmetabolicalkalosisH+ diluteurine CK↑↑withKmeasurement(repeatifnecessary)K测量（如果需要重复测量）exclude:D.m.,hypercortisolism,D.m.,bloodpressuremeasurementAssessaldosteronePAC)醛固酮smareninactivity(PRA)PAC/PRAratio(normal:0.33.8)PAC/PRA比(正常:0.3urinealdosterone/creatinineratioaftersuppression(0.05mgfludrocortison/kgfor4days)抑制后尿液醛固酮肌酐比0.05mgfludrocortison/kg，用四天imagingofadrenalglandTreatmentsurgery手术adenocarcinoma皮质Surgeryormedical?decideonindividualcasebasis lor ldxsize/invasivenessofmass肿块的大小/presenceof concurrentdx´s(renal successofmedicaltreatmentPrognosis siametsrare(alsowithcarcinoma)Drugs药物50days2,5adrenalectomy:cure,upto5 l deathduetoprogressiverenalSummaryprimaryhyperaldosteronismimportantDDforoldcatswithhypokalemiaandhyperte