慢性肾上腺皮质功能减退症误诊分析及文献复习
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摘要
目的探讨不同病因致慢性肾上腺皮质功能减退症(Adrenal Insufficiency, AI)的临床特点、诊疗思路、预后评估,提高对该类疾病的认识,减少漏诊及误诊。方法回顾性分析我院收治双侧肾上腺结核及肾上腺肿瘤患者各一例,汇总其临床资料,总结分析诊治流程,并结合相关文献进行复习。结果两例患者完善相关检查均诊断慢性肾上腺皮质功能减退,在治疗原发病的基础上给予糖皮质激素替代治疗,消化道及精神症状均明显好转,电解质恢复正常,病情好转出院,随访6月,效果满意。结论对于不明原因出现恶心、纳差、消瘦、肢体麻木,甚至精神症状等症状患者,结合患者职业史、生活环境、手术史等,应考虑AI可能,诊断明确后行糖皮质激素替代治疗,疗效显著。
Objective To study the different causes to chronic adrenal insufficiency clues, clinical characteristics, diagnosis and prognosis evaluation, improve the understanding of the disease, reduce missed diagnosis and misdiagnosis. Methods Two cases:bilateral adrenal tuberculosis and adrenal tumor in our hospital was retrospectively analyzed, the clinical data were summarized, the diagnosis and treatment process was summarized, and relevant literature was reviewed. Results Both patients were diagnosed with chronic adrenal insufficiency by relevant examinations. On the basis of the treatment of primary disease, glucocorticoid replacement therapy was given. Digestive tract and mental symptoms were significantly improved, electrolytes were restored to normal, and patients were discharged after improvement. Conclusion For patients with unexplained nausea, poor appetite, weight loss, limb numbness, and even mental symptoms, the possibility of AI should be considered in combination with the patient's occupational history, living environment, and surgical history. Glucocorticoid replacement therapy should be performed after the diagnosis is made, and the effect is significant.
Objective To study the different causes to chronic adrenal insufficiency clues, clinical characteristics, diagnosis and prognosis evaluation, improve the understanding of the disease, reduce missed diagnosis and misdiagnosis. Methods Two cases:bilateral adrenal tuberculosis and adrenal tumor in our hospital was retrospectively analyzed, the clinical data were summarized, the diagnosis and treatment process was summarized, and relevant literature was reviewed. Results Both patients were diagnosed with chronic adrenal insufficiency by relevant examinations. On the basis of the treatment of primary disease, glucocorticoid replacement therapy was given. Digestive tract and mental symptoms were significantly improved, electrolytes were restored to normal, and patients were discharged after improvement. Conclusion For patients with unexplained nausea, poor appetite, weight loss, limb numbness, and even mental symptoms, the possibility of AI should be considered in combination with the patient's occupational history, living environment, and surgical history. Glucocorticoid replacement therapy should be performed after the diagnosis is made, and the effect is significant.
引文
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[11]Mitchell AL,Pearce SH.Autoimmune Addison disease:pathophysiology and genetic complexity[J].Nat Rev Endocrinol,2012,8:306-16.
[12]Lebbe M,Arlt W.What is the best diagnostic and therapeutic management strategy for an Addison patient during pregnancy?[J].Clin Endocrinol,2013,78:497-502.
[2]任毅,张瑾,向晨昱.等.原发性慢性肾上腺皮质功能减退症15例临床特点分析及诊治体会[J].黑龙江医药,2018,31(4):746-749.
[3]申智勇,石家齐,钟渠良.肾上腺结核3例报道[J].现代泌尿外科杂志,2016,21(8):654-655.
[4]李小柳.结核感染致原发性肾上腺皮质功能减退症一例[J].临床医药文献杂志,2018,5(42):177-178.
[5]司延芳,莫冉冉.李慧婷,等.艾滋病伴肾上腺皮质功能减退症一例报告并文献复习[J].吉林大学学报(医学版),2017,43(5):1030-33.
[6]张美,张宏伟,段忠辉,等.艾滋病伴肾上腺皮质功能减退症1例报告[J].北京医学,2018,40(4):383-384.
[7]彭广波.慢性肾上腺皮质功能减退症的临床治疗体会[J].世界最新医学信息文摘,2016,16(7):172-173.
[8]Rearte B,Landoni V,Laborde E,et al.Differential effects of glucocorticoids in the establishment and maintenance of endotoxin tolerance[J].Clin Exp Immunol,2010,159(2):208-216.
[9]Odeniyi IA,Fasanmade OA,Ajala MO,et al.Comparison of low dose and standard dose adrenocorticotropin stimulation tests in healthy Nigerians[J].Afr J Med Med Sci,2010,39(2):113-118.
[10]Husebye ES,Allolio B,Arlt W,et al.Consensus statement on the diagnosis,treatment and follow-up of patients with primary adrenalinsufficiency[J].JIntern Med,2014,275(2):104-15.
[11]Mitchell AL,Pearce SH.Autoimmune Addison disease:pathophysiology and genetic complexity[J].Nat Rev Endocrinol,2012,8:306-16.
[12]Lebbe M,Arlt W.What is the best diagnostic and therapeutic management strategy for an Addison patient during pregnancy?[J].Clin Endocrinol,2013,78:497-502.