原発性アルドステロン症の診断に有用な臨床所見の検討

Primary aldosteronism（PA）is known as a secondary hypertension. Hypertensive patients are screened by the plasma aldosterone concentration（PAC）／plasma renin activity（PRA）ratio as a case-detection test for PA. However, clinical parameters for screening patients with primary aldosteronism who need adrenalectomy have not been fully elucidated. We report a case of PA who received endoscopic adrenalectomy and evaluated the clinical parameters for screening patients with primary aldosteronism who need adrenalectomy, retrospectively. We evaluated４３patients with PAC/PRA＞２００as a screening test for PA. Thirty-three（７７％） patients were diagnoses as PA after confirmation test. In１８patients who received adrenal vein sampling, １０ patients were diagnoses as unilateral adrenal adenoma. We compared clinical parameters between PA and non-PA. The level of PAC was lower in patients with PA compared to that in patients with non-PA. There were no significant change in the level of PAC, PAC/PRA, serum potassium, and blood pressure. PAC and PAC/PRA were higher and serum potassium was lower in patients who received adrenalectomy compared to those in patients without adrenalectomy. ROC curve showed that PAC＞２００ pg/mL and serum potassium ＜３．５mEq/L were useful parameters to predict diagnosis of PA who need adrenalectomy. In conclusion, PA patients with PAC＞２００pg/mL and serum potassium ＜３．５mEq/L should be considered as candidates for adrenorectomy.