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原发性醛固酮症并不少见,常误诊为高血压病,但确诊有重要意义,可经手术而获得根治或缓解。作者在本公社发现1例,14年来一直误诊为高血压病,现报告如下。男性,40岁,教师,病者于14年前发现高血压。7年前血压持续在250～280/140～160毫米汞柱,连渐出现头晕头痛、失眠,伴有心悸、夜尿多、每晚6～7次,有时竟达12次,但无尿急尿痛血尿等现象。饮水亦较多。3年来在夏天间歇性手足软弱无力。发病以来服中西药均未见症状缓解。去年5月上述症状又间歇出现。当时拟诊为原发性醛固酮症,使用安体舒通试验治疗,2天后症状逐渐明显好转,血压由270/160降至240/135毫米汞柱,停药后症状又逐渐加重。由于本院条件限制,转上级医院确诊经手术摘降左侧肾上腺腺瘤,症状逐渐消失。本例术前体检血压280/160毫米汞柱,心尖部可闻Ⅱ～Ⅲ级收缩期杂音,期前收缩10～15次/分,A_2>P_2,肝肋下1厘米外,其它未见异常。尿常规.pH6.4、蛋白+、白细胞+、红细胞+。X线胸透:双肺正常,主动脉型心脏。心电图检查:频发性室性期前收缩,心肌劳损。本例误诊14年之久,主要是我们对本病认识不足。病者从青年时期血压增高,但一直未被引起重视
Primary aldosteronism is not uncommon, often misdiagnosed as hypertension, but the diagnosis is of great significance, can be cured by surgery or remission. The author found in the commune in 1 case, 14 years has been misdiagnosed as hypertension, are as follows. Male, 40 years old, teacher, patient Hypertension was discovered 14 years ago. 7 years ago, blood pressure continued to 250 ~ 280/140 ~ 160 mm Hg, and even gradually dizziness and headache, insomnia, accompanied by palpitations, nocturia and more, 6 to 7 times per night, sometimes as much as 12 times, but no urgency Dysuria, hematuria and other phenomena. More water. 3 years in the summer intermittent hand, foot weakness. Since the onset of Chinese and Western medicine have seen no symptoms. In May last year, the above symptoms appeared intermittently. At the time of diagnosis of primary aldosteronism, the use of spironolactone test treatment, 2 days after the symptoms gradually improved, blood pressure dropped from 270/160 to 240/135 mm Hg, after stopping the symptoms gradually increased. Due to hospital conditions, go to the superior hospital diagnosed by surgical removal of the left adrenal adenoma, the symptoms gradually disappear. Preoperative blood pressure 280/160 mm Hg in this case, the apex can be heard Ⅱ ~ Ⅲ systolic murmur, before the contraction of 10 to 15 beats / min, A_2> P_2, 1 cm below the liver ribs, the other no exception . Urine routine. PH6.4, protein +, white blood cells +, red blood cells +. Chest X-ray: normal lungs, aortic heart. ECG: frequent ventricular contraction, myocardial strain. Misdiagnosis of 14 cases in this case, mainly because of our lack of knowledge of the disease. The patient’s blood pressure increased from youth, but has not been taken seriously