原发性肾上腺皮质功能减退症临床分析

目的:分析原发性肾上腺皮质功能减退症（PAI）的临床特点。方法:以促肾上腺皮质激素（ACTH，参考范围0～46 pg/mL）水平大于上限2倍为前提，根据清晨血皮质醇（Cor，参考范围为5～25 μg/dL）是否小于5 μg/dL将31例原发性肾上腺皮质功能减退症的患者分为A组（Cor＜5 μg/dL）与B组（5 μg/dL≤Cor＜25 μg/dL，伴有糖皮质激素/盐皮质激素缺乏的症状或体征)，对其临床资料（临床表现及实验室检查）进行回顾性分析并将两组进行对比。结果:A组及B组的临床表现中均以色素沉着、乏力、消化系统症状（纳差、恶心、呕吐）、体重减轻最为常见，A组的上述临床表现的发生率分别为83.33%、75%、75%和50%，B组的上述临床表现的发生率分别为73.68%、63.16%、63.16%和42.11%，两组的临床表现差异均无统计学意义（均P＞0.05）；本研究中主要分析的实验室检查项目为血红蛋白、Na、K、Ca、P和催乳素，两组的上述检查结果均无明显差异（均P＞0.05）。结论:对于临床上可疑PAI的患者要做好筛查工作，不应严格按照清晨血Cor＜5 μg/dL、ACTH＞2倍上限为初步诊断标准。

Clinical analysis of primary adrenocortical insufficiency

Objective: To analyze the clinical characteristics of primary adrenocortical insufficiency（PAI）. Methods:On the basis of serum corticotropin （ACTH，reference range 0-46 pg/mL） concentration was 2 times higher than the upper limit of normal range，morning plasma cortisol（Cor，reference range 5-25 μg/dL） less than 5 μg/dL，31 patients with PAI were classified with group A（Cor＜5 μg/dL） and group B（5 μg/dL≤Cor＜25 μg/dL，with symptoms or signs of glucocorticoid/mineralocorticoid deficiency）. The clinical data（clinical manifestations and laboratory tests） were analyzed retrospectively and compared between the two groups. Results:Pigmentation，fatigue，digestive system symptoms（anorexia，nausea，vomiting） and weight loss were the most common clinical manifestations of both group A and group B. The above-mentioned clinical manifestations of group A accounted for 83.33%，75%，75% and 50%，respectively. The above-mentioned clinical manifestations of group B accounted for 73.68%，63.16%，63.16%，and 42.11%，respectively. There was no statistical difference in clinical manifestations between the two groups（all P>0.05）. The main laboratory examination items in this study were Hb，Na，K，Ca，P and prolactin，and there was no significant difference in laboratory examination results between the two groups（all P>0.05）.Conclusion:In clinical practice，when patients are suspected PAI，further detailed screening is needed. Early morning Cor<5 μg/dL and plasma ACTH>2 times upper limit should not be strictly regarded as the preliminary diagnostic criteria.