1.The Second Clinical College, Beijing University of Chinese Medicine, Beijing 100029, China;
2.Department of Cardiology, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing 100078, China;
3.the Third Clinical College of Beijing University of Chinese Medicine, Beijing 100029, China
Abstract：For hypertension with hypokalemia, primary aldosteronism is given priority clinically. This article reports a case of hypertension with hypokalemia rather than primary aldosteronism to remind clinicians not to fall into the “trap”. The patient was admitted to the hospital for “intermittent dizziness and fatigue for three months”. After admission, he was found to be low in blood potassium. Losartan potassium and Hydrochlorothiazide Tablets were discontinued, and Felodipine Sustained-release Tablets combined with Potassium Chloride Sustained-release Tablets were found to have blood pressure significantly elevated and persistently low serum potassium, primary aldosteronism was initially considered, and Spironolactone was added on this basis, and eventually the patient’s blood pressure and serum potassium returned to normal. A retrospective medical history revealed that the patient had taken Compound Glycyrrhizin, and adverse reactions such as hypokalemia and pseudoaldosteronism might occur when the drug was used simultaneously with Thiazide Diuretics. This article aims to remind clinicians of the importance of detailed medical history, especially medication history, and should have a sound clinical thinking and diagnosis and treatment model, and at the same time improve the understanding of primary aldosteronism.
[1] Funder JW. Primary Aldosteronism [J]. Hypertension，2019， 74（3）：458-466.
[2] 蒋怡然，王卫庆.中国原发性醛固酮增多症诊治专家共识解读[J].诊断学理论与实践，2016，15（4）：350-353.
[3] 惠汝太，孔涛，赵晟，等.高血压相关基因研究进展[J].中国实用内科杂志，2019，39（1）：27-37.
[4] Burrello J，Monticone S，Buffolo F，et al. Is There a Role for Genomics in the Management of Hypertension？[J]. Int J Mol Sci，2017，18（6）：1131.
[5] 陈歆，程艾邦，许建忠，等.中国高血压患者原发性醛固酮增多症的前瞻性筛查研究进展[J].诊断学理论与实践，2020，19（5）：450-453.
[6] Burrello J，Monticone S，Losano I，et al. Prevalence of Hypokalemia and Primary Aldosteronism in 5100 Patients Referred to a Tertiary Hypertension Unit [J]. Hypertension，2020，75（4）：1025-1033.
[7] Bakris G，Ali W，Parati G. ACC／AHA Versus ESC／ESH on Hypertension Guidelines：JACC Guideline Comparison [J]. J Am Coll Cardiol，2019，73（23）：3018-3026.
[8] Deutch MR，Grimm D，Wehland M，et al. Bioactive Candy：Effects of Licorice on the Cardiovascular System [J]. Foods，2019，8（10）：495.
[9] Li J，Fan X，Wang Q. Hypertensive crisis with 2 target organ impairment induced by glycyrrhizin：A case report [J]. Medicine，2018，97（11）：e0073.
[10] Shen H，Xu ZX，Li QF. New advances in the diagnosis of primary aldosteronism [J]. Chronic Dis Transl Med，2020， 6（1）：1-5.
[11] Pillai PR，Griffith M，Schwarcz MD，et al. Primary Aldosteronism：Cardiovascular Risk，Diagnosis，and Management [J]. Cardiol Rev，2020，28（2）：84-91.
[12] 中华医学会内分泌学分会.原发性醛固酮增多症诊断治疗的专家共识（2020版）[J].中华内分泌代谢杂志，2020，36（9）：727-736.
[13] 魏强，朱育春.原发性醛固酮增多症的功能分型诊断：肾上腺静脉采血专家共识[J].现代泌尿外科杂志，2020， 25（3）：205-208.
[14] Funder JW，Carey RM，Mantero F，et al. The Management of Primary Aldosteronism：Case Detection，Diagnosis，and Treatment：An Endocrine Society Clinical Practice Guideline [J]. J Clin Endocrinol Metab，2016，101（5）：1889-1916.
[15] 佚各.原发性醛固酮增多症诊断治疗的专家共识[J].中华内分泌代谢杂志，2016，32（3）：188-195.
[16] Williams TA，Burrello J，Sechi LA，et al. Computed Tomography and Adrenal Venous Sampling in the Diagnosis of Unilateral Primary Aldosteronism [J]. Hypertension，2018，72（3）：641-649.
[17] Hundemer GL，Vaidya A. Primary Aldosteronism Diagnosis and Management：A Clinical Approach [J]. Endocrinol Metab Clin North Am，2019，48（4）：681-700.
[18] 武媛媛，顾坤，高茜茜，等.甘草类制剂不良反应及其机制研究进展[J].药物评价研究，2018，41（7）：1363-1368.
[19] 王永洪，兰婉莹，陈恬.甘草酸体外抗人巨细胞病毒AD169的作用[J].中成药，2016，38（10）：2121-2127.
[20] 胡晶晶.柴芍二至散治疗甲亢伴肝损害MDA、SOD、AOPP水平的临床研究[D].合肥：安徽中医药大学，2018.
[21] Smedegaard SB，Svart MV. Licorice induced pseudohyperaldosteronism，severe hypertension，and long QT [J]. Endocrinol Diabetes Metab Case Rep，2019：19-0109.
[22] Penninkilampi R，Eslick EM，Eslick GD. The association between consistent licorice ingestion，hypertension and hypokalaemia：a systematic review and meta-analysis [J]. J Hum Hypertens，2017，31（11）：699-707.
[23] Katharina RB，Lucija T，Chris JK，et al. Molecular mechanisms of posaconazole-and itraconazole-induced pseudohyperaldosteronism and assessment of other systemically used azole antifungals [J]. J Steroid Biochem Mol Biol，2020，199：105605.
[24] Gruber S，Beuschlein F. Hypokalemia and the Prevalence of Primary Aldosteronism [J]. Horm Metab Res，2020，52（6）：347-356.
[25] Yozamp N，Vaidya A. The Prevalence of Primary Aldosteronism and Evolving Approaches for Treatment [J]. Curr Opin Endocr Metab Res，2019，8：30-39.
[26] 王陈芳，李红，孙水雅，等.安胃疡胶囊致高血压合并低钾血症1例[J].中国中西医结合杂志，2020，27（11）：1-3.
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