肾上腺皮质功能减退症的诊断和鉴别诊断

肾上腺皮质功能减退症按病因可分为原发性和继发性，按病程可分为慢性和急性，现分述如下：１原发性肾上腺皮质功能减退症１．１病因和发病机制１．１．１慢性起病原发性慢性肾上腺皮质功能减退症，即阿狄森（Ａｄｄｉｓｏｎ）病，发病率不高，我国尚无确切的流行病学资料。其病因主要有：肾上腺结核：在结核病发病率高的国家和地区，是原发性肾上腺皮质功能减退症的首要原因，双侧肾上腺组织被破坏的程度常常超过９０％，约５０％的患者有肾上腺钙化，肾上腺体积明显增大。自身免疫性肾上腺炎：过去称为特发性肾上腺皮质萎缩，肾上腺皮质呈…     

药源性肾上腺皮质功能减退症因恶心呕吐误诊胃炎

目的探讨继发性肾上腺皮质功能减退症的临床特点及误诊原因,以提高临床确诊率。方法回顾性分析误诊为慢性胃炎的继发性肾上腺皮质功能减退症1例的临床资料。结果本例因食欲缺乏伴恶心、呕吐1个月,发热20 d入院。曾先后2次在当地医院就诊,按慢性胃炎予抑酸、止吐等治疗无效。入我院后经详细询问病史(患慢性阻塞性肺疾病20余年并间断不规则应用糖皮质激素史),结合低血压、低钠血症临床表现,查血皮质醇、血管紧张素Ⅰ、17酮类固醇、17羟类固醇及肾上腺CT、垂体MRI平扫及增强扫描确诊为继发性肾上腺皮质功能减退症。予糖皮质激素替代治疗,病情明显好转出院。后以泼尼松5 mg/d维持,病情稳定。结论继发性肾上腺皮质功能减退症临床表现较为隐匿,易误诊,临床应高度关注。     

继发性肾上腺皮质功能减退症临床分析

慢性肾上腺皮质功能减退症是各种原因引起肾上腺皮质功能低下的疾病,从病因上可分为原发性和继发性肾上腺皮质功能减退症.近年来继发性肾上腺皮质功能减退症的发病率较前有升高趋势[1].但其发病较隐匿,早期症状缺乏特异性,临床早期诊断率不高.本研究对21例继发性肾上腺皮质功能减退症患者的临床资料进行回顾分析,旨在探讨该病的病因构成和早期诊断的意义,以加深临床医生对于本病的认识.     

肺结核并肾上腺结核致肾上腺危象一例并文献复习

目的探讨肺结核并肾上腺结核致肾上腺危象的临床特点,减少误诊误治。方法回顾分析1例肺结核继发肾上腺结核致肾上腺危象的临床资料,并复习相关文献。结果本例以咳嗽、气短、盗汗、乏力、全身色素沉着和严重低钠、低氯血症为主要表现就诊,外院诊断为双肺结核、右肾上腺瘤。入我院后经相关检查诊断为菌阴肺结核,经相应治疗无好转,进一步经皮质醇节律测定确诊为肺结核并肾上腺结核,肾上腺危象。予抗结核治疗及糖皮质激素替代治疗,病情改善。4个月后随访,病情明显好转,仍在治疗中。结论对于结核病并肾上腺占位性病变患者,应注意鉴别肺结核与肾上腺结核是否并存,尤其要警惕是否并发原发性肾上腺皮质功能减退症的可能。     

原发性肾上腺非霍奇金淋巴瘤伴垂体及肾上腺皮质功能减退1例

原发性肾上腺非霍奇金淋巴瘤伴垂体及肾上腺皮质功能减退临床上较少见，本院曾收治1例，报道如下。     

蒙医蒙药治疗原发性肾上腺皮质功能减退症

原发性肾上腺皮质功能减退症，又称艾迪生病(Addison‘s disease)，是由于自身免疫、结核和真菌等感染，肿瘤、白血病等原因破坏肾上腺的绝大部分引起肾上腺皮质激素分泌不足所致。临床表现为消瘦、乏力、皮肤黏膜色素沉着、低血压及胃肠功能失调等症状的症候群。本病症多见于成年人，且临床上少见，症状不明显，甚至失治误治，有时产生肾上腺危象时才能就医确诊。     

慢性肾上腺皮质功能减退症70例临床分析

目的：复习原发性和继发性慢性肾上腺皮质功能减退症的病因和临床特点。方法：回顾性分析70例慢性肾上腺皮质功能减退症的临床资料。结果及结论：原发性和继发性的慢性肾上腺皮质功能减退症病因分别以结核及席汉综合征为多。两者共有表现为食欲减退、疲乏无力、体重减轻、低血压、贫血、低钠血症、低血糖和血皮质醇、尿皮质醇降低。原发性者以色素沉着和血浆促肾上腺皮质激素（ACTH）值升高为特点,可见高钾血症;继发性者则表现肤色浅淡,常有多种垂体激素缺乏表现,ACTH降低或正态,无高钾血症。     

1例艾迪森氏病病人的危象护理

艾迪森氏病又称原发性慢性肾上腺皮质功能减退症,系由于双侧肾上腺绝大部分被破坏所致,全身皮肤、黏膜色素加深为其临床症状.肾上腺危象为本病急骤加重的表现,应予以积极抢救[1].     

Addison''''s病的CT诊断

Addison′s病即原发性肾上腺皮质功能减退症,由双侧肾上腺皮质破坏所致,其原因主要为自体免疫所致的特发性肾上腺皮质萎缩及肾上腺结核。本文通过11例Addison′s病的报告,总结了本病的CT表现,强调肾上腺由双侧增大向小的钙化的腺体演变的过程,提出CT可在Addison′s病早期显示出病变,故对早期诊断、早期治疗以使肾上腺功能恢复具有重要意义。     

1例艾迪森氏病病人的危象护理

艾迪森氏病又称原发性慢性肾上腺皮质功能减退症，系由于双侧肾上腺绝大部分被破坏所致，全身皮肤、黏膜色素加深为其临床症状。肾上腺危象为本病急骤加重的表现，应予以积极抢救。主要治疗为静脉输注糖皮质激素及补充盐水、葡萄糖以及治疗存在的应激状态。我院2005年6月收治1例艾迪森氏病病人，经过精心的治疗和护理，好转出院。现将其护理总结如下。     

Epiglottic tuberculosis in a patient treated with steroids for Addison's disease

Isolated epiglottic tuberculosis (TBC) is uncommon and has rarely been described. We report the case of a 40-year-old man with tuberculous involvement of the epiglottis and primary adrenal insufficiency. Endoscopic examination showed a severely swollen epiglottis with granulomatous and partially necrotic mucosa. The patient has been treated with glucocorticoids for four years due to primary adrenocortical insufficiency. We therefore assume that tuferculous involvement of epiglottis is due to the reactivation of pulmonary TBC. We also discuss differential diagnosis and management of epiglottic TBC and Addison's disease.     

The clinical significance of the radioimmunological determination of plasma ACTH (author's transl)]

The clinical significance of the direct determination of plasma ACTH was investigated in healthy persons and in patients with primary or secondary adrenocortical insufficiency, with Cushing's syndrome or with acromegaly. The sensitivity of the radioimmunological method facilitated the detection of diurnal changes in plasma ACTH in healthy subjects and of variations in plasma ACTH after the administration of dexamethasone and glucagon. The determination of plasma ACTH appears to be a useful procedure of diagnostic value in patients suffering from primary adrenal insufficiency accompanied by high concentrations of plasma ACTH. However, in patients suffering from Cushing's syndrome or secondary adrenocortical insufficiency it is still essential to carry out the dexamethasone suppression test or the metopiron test, respectively.     

Adrenocortical insufficiency in the critically ill patient.

The fluid and electrolyte imbalances associated with adrenocortical failure affect multiple physiologic systems in the critically ill patient. Because of its widespread effect, the objective signs of adrenocortical failure may escape recognition. In the context of shock states affecting the function of multiple organs that have been previously diagnosed, empirical evidence suggesting the presence of adrenal insufficiency may be attributed to the primary diagnosis and illness. However, it is most important that critical care nurses question whether adequate adrenal function is present. When effective patient assessment and management are standard components of care, adrenocortical dysfunction may be reversed, while failure to assess for signs of adrenal insufficiency may lead to irreversible patient outcomes. This paper describes phenomena of adrenocortical failure in critically ill patients and presents the problems of fluid and electrolyte imbalance that accompany them.     

Acute adrenocortical crisis: three different presentations

The adrenal cortex normally produces three principal steroid hormones: the glucocorticoid cortisol, the mineralocorticoid aldosterone, and a small quantity of sex steroids. In primary adrenocortical insufficiency, there is a deficiency of both cortisol and aldosterone with characteristic clinical and laboratory findings. In contrast, with a pituitary disorder there is isolated hypocortisolism, because its production is dependent on pituitary adrenocorticotropic hormone (ACTH), whereas aldosterone production is controlled by extracellular fluid volume, renin and serum potassium. Acute adrenocortical crisis is an absolute medical emergency and its presentation is not always typical. We describe three recent cases of acute adrenocortical crisis in our hospital who presented in three different ways in three different wards.     

Acute adrenal insufficiency after a single dose of etomidate

Acute adrenocortical insufficiency is a critical care emergency characterized by hemodynamic instability, lethargy, and cardiovascular collapse. Acute adrenal insufficiency has many etiologies, from rapid withdrawal of exogenous glucocorticoids to adrenocortical destruction to poor adrenal reserve after administration of steroid synthesis inhibitors. Etomidate, a parenteral hypnotic agent, is a steroid synthesis inhibitor. Although the use of continuous etomidate infusion in the intensive care unit fell from favor secondary to reports of adrenal crisis, single-dose etomidate for induction of anesthesia is common for the hemodynamically unstable patient or in patients who may not tolerate wide variance in heart rate or blood pressure. A case is presented of acute adrenocortical insufficiency and crisis after a standard induction dose of etomidate. Acute adrenal insufficiency should be suspected in intensive care unit patients who have undergone general anesthesia with etomidate induction and present with hypotension refractory to standard vasopressor administration.     

Addison's disease with enlarged adrenal glands in sonography and computer tomography. Differential diagnostic considerations based on 2 cases of tuberculous adrenalitis

One of the major causes of chronic adrenal insufficiency (Addison's disease) is tuberculous adrenalopathy. Since sonography and computed tomography have become generally available in recent years and are of potential help in the diagnosis of this disease the merits of these methods are discussed in the light of 2 cases of adrenal tuberculosis, followed by a review of the literature. Adrenal calcification is the most significant, although not specific sign of adrenal insufficiency due to tuberculosis. Computed tomography has proven to be the method of choice in the non-invasive diagnosis of tuberculous adrenalopathy and in the monitoring of tuberculostatic treatment in this disease. Sonography is helpful as a preliminary investigation.     

原发性肾上腺淋巴瘤的诊断与临床处理

原发性肾上腺淋巴瘤(primary adrenal lymphoma,PAL)临床表现不典型,多数患者存在局部疼痛或全身发热、消瘦症状,在双侧受累患者中肾上腺皮质功能不全很常见,但仅少数患者进行全面系统的检查。正电子发射断层扫描/计算机体层成像是定性定位诊断这类肾上腺肿瘤的有效手段,磁共振成像用来区别肾上腺淋巴瘤与皮质癌尚有待更多研究证实。对于PAL的治疗尚需进一步研究,以对此类患者制定最佳的诊疗方案。目前,尚不清楚利妥昔单克隆抗体联合CHOP方案(环磷酰胺+阿霉素+长春新碱+强的松)治疗高危侵袭性PAL患者是否可提高患者完全反应率。病变早期,尤其是在肾上腺皮质功能不全出现之前诊断PAL,有助于减少患者的发病率和死亡率。     

原发性肾上腺淋巴瘤的诊断与临床处理

原发性肾上腺淋巴瘤(primary adrenal lymphoma, PAL)临床表现不典型, 多数患者存在局部疼痛或全身发热、消瘦症状, 在双侧受累患者中肾上腺皮质功能不全很常见, 但仅少数患者进行全面系统的检查。正电子发射断层扫描/计算机体层成像是定性定位诊断这类肾上腺肿瘤的有效手段, 磁共振成像用来区别肾上腺淋巴瘤与皮质癌尚有待更多研究证实。对于PAL的治疗尚需进一步研究, 以对此类患者制定最佳的诊疗方案。目前, 尚不清楚利妥昔单克隆抗体联合CHOP方案(环磷酰胺+阿霉素+长春新碱+强的松)治疗高危侵袭性PAL患者是否可提高患者完全反应率。病变早期, 尤其是在肾上腺皮质功能不全出现之前诊断PAL, 有助于减少患者的发病率和死亡率。     

The incidence of relative adrenal insufficiency in patients with septic shock after the administration of etomidate

Introduction  

Etomidate blocks adrenocortical synthesis when it is administered intravenously as a continuous infusion or a single bolus. The influence of etomidate administration on the incidence of relative adrenal insufficiency in patients with septic shock has not been formally investigated. The objective of this study was to determine the incidence of relative adrenal insufficiency in patients with septic shock after etomidate administration compared with patients with septic shock who did not receive etomidate.     

Changes in the functional status of the adrenal glands in patients with chronic renal failure during the treatment by programmed hemodialysis

A study was made of adrenal function in 2 groups of patients with chronic renal insufficiency on programmed hemodialytic therapy. Insufficiency of gluco- and mineralo-corticoid function of the adrenal glands and hyperfunction of their medulla developed in patients with normal BP and controlled hypertension. In patients with uncontrolled hypertension, insufficiency of adrenal glucocorticoid function was attended by hypercatecholaminemia and aldosteronism. Genesis of the revealed disorders was associated with the loss of hormones into the dialysing solution through the membrane, depletion of adrenocortical functional reserves and disturbance of pulmonary regulation of the level of biologically active substances as a result of microthromboembolization of the vessels of the lesser circulation attending hemodialysis.