2譯esavs final醛固酮增多癥

Dr.AstridWehner,Dipl.ECVIM-ESAVS,FelineMedicineandSurgery4–EndocrinologyandReproductionShanghai,Sept.22nd–26th,2014DSH,13yearsm/nindoorwithaccesstohasnotbeenvaccinatedordewormedrecentlyHistorycaeseveralhasdevelopedacuteweakness3daysPhysicalexamLethargicheart:160 心率160abdominalpalpation:possiblemasseffectmid-abdomen,approx.1x1cm Problemlistanemia,↓glucose,↓potassium,↓↑c(diǎn)alcium,systemicdiseasepain,feverDDs?abdominalmass腹部腫塊 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低鉀血癥intracellularshiftinsulinexchang-ewithprotonsH+(alkalosis,adn-

of )與氫離子交換（堿毒癥，注入 LossGI(Vomiting,消化道（，拉稀KidneysCKDhyperthyroidsm,hyperaldosteronismpostobstructivediuresis甲亢，高醛固酮癥，去梗阻后利尿DDsCK肌酸激酶damagetomusclecellsSkeletalTraumaMyositisCramps,seizures肌肉，癲HeartMyocarditisInfarctDDs?adrenalmass腎上腺腫塊metastasis,hemorrhage,MedullaCortexGlucocorticoidsAldosteronehormonesParesis輕度↑CK↑c(diǎn)ause:aldosteroneprod.adrenaladrenalmassproductive:prod.NextdiagnosticbloodpressuremeasurementBloodpressure280mmHgsyst.(averageof5DefinitionofhypertensionwhitecoateffectCatskidneydiabetes01000Cats0100罕見0IRISsubstageriskoftargetorgandamage(mmHg)(mmEvidenceofTODTOD的KidneyprogressionofCKDEyeBrainEvidenceofvesselsandheartcardiacfailureEpistaxisIndicationsforevaluating ialsignsassociatedwithhypertensiveTODdiseasesassociatedwithReference40-195EffectsofaldosteroneHypertensionNaretentionNabloodvolumePolymyopathyKexcretionKmetabolicalkalosisRemodelingcardiacfibrosis Aldosteronerenin腎素cause:adrenalhypersia,adrenalcarcinomaor–adenomaAldosterone↑:activationofcause:cong.heartfailure,renaldx,liverfailurePrim. sia l ladenomacarcinoma腺瘤，equal sia l, l?)雙側(cè)，（單側(cè)Prim.signalment:oldercats,median13clinic:weakness,ventroflexion,PU/PD,anorexia,weightloss,ataxia,blindnessecho:adrenalmassoradrenal polyendocrinopathiesLaboratorypotassiummild–moderate↓鉀離子輕度 sodiumnormal(mild鈉離子正常（輕度升高dilutionduetowaterretentionmetabolicalkalosisH+ diluteurine CK↑↑withKmeasurement(repeatifnecessary)K測量（如果需要重復(fù)測量）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手術(shù)adenocarcinoma皮質(zhì)Surgeryormedical?decideonindividualcasebasis lor ldxsize/invasivenessofmass腫塊的大小/presenceof concurrentdx′s(renal successofmedicaltreatmentPrognosis siametsrare(alsowithcarcinoma)Drugs藥物50days2,5adrenalectomy:cure,upto5 l deathduetoprogressiverenalSummaryprimaryhyperaldosteronismimportantDDforoldcatswithhypokalemiaandhyperte