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临床上单纯醛固酮低下者少见。现将临床听见一例报告如下。 患者男,21岁。肢体无力3年,因吞咽、呼吸困难及四肢不能活动1周入院,否认类似家族史及流行病史。体检:血压15/10kPa,发育正常,皮肤苍白,一般内科检查无异常。神经系统检查:神志清楚,吐词不清带重鼻音,咀嚼无力,抬头、转头、咳嗽及翻身困难,肩胛带、骨盆带及四肢肌肉均匀消瘦。双上肢近端及下肢肌力Ⅲ级,肌张力低,腱反射消失.,无病理反射,无肌强直,无感觉障碍及疼痛。实验室检查:连续5次测定血钾>6.3mmol/L,血钠<130mmol/L,尿排钾<21mmol/24小时,尿排钠>250mmol/24小时,放免法测血醛固酮卧位4次为7.2～147.9pmol/L(本实验室正常值为257～362pmol/L),皮贡醇8a.m为242.8nmol/L,4P.m为151.8nmol/L,尿睾酮19.5nmol/L,空腹血糖3.4～4.6mmol/L,糖耐量提示曲线平直,血肌酐、尿素氮、尿液分析结果均正常,免疫功能检查CH_(50)50U/ml,IgG10.0g/L,IgA1.5g/L、IgM1.1g/L、C_(?)1.8g/L。限钠每日20mEq(0.46g)1固后测血醛固酮卧位147pmol/L、直立位218.8pmol/L。心电图示高血钾T波改变,肾上腺CT扫描未见异常,腓肠肌活检提示慢性肌病性肌萎缩。在予限钾、高钠及地塞米松治疗1个月后,血钾钠恢复正常水平,肌无力明显改善,可上下一层楼梯,随
Allergic simple aldosterone clinical rare. Now hear a clinical report is as follows. Patient male, 21 years old. Physical weakness for 3 years, due to swallowing, difficulty breathing and limbs can not be active for 1 week admission, denied similar family history and epidemic history. Physical examination: blood pressure 15 / 10kPa, normal development, pale skin, the general medical examination was normal. Nervous system examination: Consciousness, unclear articulation with heavy nasal sounds, chewing weakness, looking up, turning around, coughing and turning difficulties, shoulder girdle, pelvic bands and limbs and muscles were thinner. Upper extremity proximal and lower limb muscle strength Ⅲ, low muscle tension, tendon reflex disappeared., No pathological reflex, no muscle rigidity, no sensory disturbances and pain. Laboratory tests: Serum potassium> 6.3mmol / L, serum sodium <130mmol / L, urinary potassium <21mmol / 24 hours and urinary sodium> 250mmol / 24 hours were measured five times in a row. Was 7.2 ~ 147.9pmol / L (normal in this laboratory was 257 ~ 362pmol / L), 8m of picatinol was 242.8nmol / L, 4P.m was 151.8nmol / L, urinary testosterone 19.5nmol / L, fasting Blood glucose 3.4 ~ 4.6mmol / L, glucose tolerance curve was straight, serum creatinine, urea nitrogen, urine analysis were normal, immune function tests CH5050U / ml, IgG10.0g / L, IgA1.5g / L , IgM1.1g / L, C _ (?) 1.8g / L. Limit sodium daily 20mEq (0.46g) 1 solid measured serum aldosterone supine 147pmol / L, upright position 218.8pmol / L. ECG showed hyperkalemia T wave changes, adrenal CT scan showed no abnormalities, gastrocnemius muscle biopsy prompted chronic myopathy muscle atrophy. After the limited potassium, sodium and dexamethasone treatment for 1 month, serum potassium sodium returned to normal levels, muscle weakness improved significantly, can be a staircase up and down, with