以肾上腺结节样增生伴皮质醇升高首诊的原发性肾上腺皮质功能减退症1例
Primary Adrenal Insufficiency with Adrenal Nodular Hyperplasia and Elevated Cortisol: A Case Report and Literature Review
摘要: 对以肾上腺结节样增生伴早期ACTH、皮质醇升高首诊的原发性肾上腺皮质功能减退的1例病例资料进行回顾性分析。结合皮质醇、ACTH节律和水平及结核相关检测考虑为结核所致原发性肾上腺皮质功能减退症。以肾上腺结节样增生伴ACTH及皮质醇升高首发就诊的患者需警惕发生原发性肾上腺皮质功能减退症的可能,需定期监测ACTH及皮质醇的水平及节律,避免漏诊及误诊。
Abstract: We report a patient of primary adrenal insufficiency with adrenal nodular hyperplasia and elevated cortisol. Combined with cortisol, ACTH rhythm and level, and tuberculosis-related testing, the primary adrenal insufficiency caused by tuberculosis was considered. Patients with adrenal nodular hyperplasia accompanied by elevated ACTH and cortisol should be alert to the possibility of primary adrenal insufficiency, and the levels and rhythm of ACTH and cortisol should be regularly monitored to avoid missed diagnosis and misdiagnosis.
文章引用:郝文卿, 王青, 王飞, 徐丽丽, 吕雪, 韩玉鑫, 杨乃龙. 以肾上腺结节样增生伴皮质醇升高首诊的原发性肾上腺皮质功能减退症1例[J]. 临床医学进展, 2020, 10(7): 1410-1415. https://doi.org/10.12677/ACM.2020.107212

参考文献

[1] Erichsen, M.M., Løvås, K., Fougner, K.J., et al. (2009) Normal Overall Mortality Rate in Addison’s Disease, But Young Patients Are at Risk of Premature Death. European Journal of Endocrinology, 160, 233. [Google Scholar] [CrossRef
[2] Løvås, K. and Husebye, E.S. (2010) High Prevalence and Increasing Incidence of Addison’s Disease in Western Norway. Clinical Endocrinology, 57, 787-791. [Google Scholar] [CrossRef] [PubMed]
[3] Barthel, A., Benker, G., Berens, K., et al. (2018) An Update on Addison’s Disease. Experimental and Clinical Endocrinology & Diabetes, 127, 165-175.
[4] 廖二元. 内分泌代谢病学第3版上[M]. 北京: 人民卫生出版社, 2012.
[5] Betterle, C., Presotto, F. and Furmaniak, J. (2019) Epidemiology, Pathogenesis, and Diagnosis of Addison’s Disease in Adults. Journal of Endocrinological Investigation, 42, 1407-1433. [Google Scholar] [CrossRef] [PubMed]
[6] 李延兵, 胡国亮, 姚斌, 等. 慢性肾上腺皮质功能减退症70例临床分析[J]. 新医学, 2001, 32(4): 207.
[7] 唐小燕, 张晓文, 韩宙欣, 等. 肾上腺结核致艾迪生病23例[J]. 中国医刊, 2001, 36(10): 45-46.
[8] Melmed, S., Polonsky, K.S., Larsen, P.R. and Kronenberg, H.M. (2011) Williams Textbook of Endocrinology. 12th Edition, Elsevier, Amsterdam.
[9] Ahasic, A.M. and Ramaswamy, A. (2017) Adrenal Insufficiency. Springer International Publishing, Berlin. [Google Scholar] [CrossRef
[10] Schöfl, C., Mayr, B. and Maison, N. (2019) Daily Adjustment of Glucocorticoids by Patients with Adrenal Insufficiency. Clinical Endocrinology, 91, 256-262. [Google Scholar] [CrossRef] [PubMed]
[11] Pramanik, S. (2017) Primary Hypothyroid and Secondary Adrenal Insufficiency-Searching the Missing Link. Journal of Clinical & Diagnostic Research, 11, OJ01. [Google Scholar] [CrossRef
[12] 郑鹏杰, 张少玲. 肾上腺皮质功能减退症的诊治现状[J]. 内科急危重症杂志, 2019, 25(1): 73-79.
[13] 李嫔. 原发性肾上腺皮质功能减退临床诊断[J]. 中国实用儿科杂志, 2016, 31(6): 414-418.
[14] Vita, J.A., Silverberg, S.J., Goland, R.S., et al. (1985) Clinical Clues to the Cause of Addison’s Disease. The American Journal of Medicine, 78, 461-466. [Google Scholar] [CrossRef] [PubMed]
[15] Keleştimur, F., Unlu, Y., Ozesmi, M., et al. (1994) A Hormonal and Radiological Evaluation of Adrenal Gland in Patients with Acute or Chronic Pulmonary Tuberculosis. Clinical Endocrinology, 41, 53-56. [Google Scholar] [CrossRef] [PubMed]
[16] Kelestimur, F. (2004) The Endocrinology of Adrenal Tuberculosis: The Effects of Tuberculosis on the Hypothalamo-Pituitary-Adrenal Axis and Adrenocortical Function. Journal of Endocrinological Investigation, 27, 380-386. [Google Scholar] [CrossRef
[17] Joshi, A.S. and Woolf, P.D. (2005) Pituitary Hyperplasia Secondary to Primary Hypothyroidism: A Case Report and Review of the Literature. Pituitary, 8, 99-103. [Google Scholar] [CrossRef] [PubMed]
[18] Schneller, C., Finkel, L., Wise, M., Hageman, J.R. and Littlejohn, E. (2013) Autoimmune Polyendocrine Syndrome: A Case-Based Review. Pediatric Annals, 42, 203-208. [Google Scholar] [CrossRef] [PubMed]
[19] Bornstein, S.R., Allolio, B., Arlt, W., et al. (2016) Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology & Metabolism, 101, 364-389. [Google Scholar] [CrossRef] [PubMed]