沙库巴曲缬沙坦致男性腹膜透析患者乳腺发育一例

A case of gynecomastia induced by sacubitril/valsartan in a patient undergoing continuous ambulatory peritoneal dialysis

一例中年男性尿毒症维持性腹膜透析患者,因双侧乳房胀痛3 d于门诊就诊,体查及超声检查提示乳腺发育。近半个月新增口服药物沙库巴曲缬沙坦,既往无肝病、内分泌及肿瘤病史,无性激素类及其他特殊药物用药史。初步考虑沙库巴曲缬沙坦所致的药源性男性乳腺发育,予以停用沙库巴曲缬沙坦,半个月后乳腺结节缩小,1个月后乳腺结节消退,乳房胀痛好转。结合文献复习及分析,最终诊断为沙库巴曲缬沙坦所致男性乳腺发育。本病例报道有助于增加医务工作者对沙库巴曲缬沙坦罕见不良反应的认识,进一步了解沙库巴曲缬沙坦在尿毒症腹膜透析患者中的应用,减少对患者生活质量及预后的影响,也对该药物作用机制探索提供了一定的启示。

A 31-year-old male patient with end-stage renal disease on maintenance peritoneal dialysis present-ed to the Outpatient Department with bilateral breast pain for three days.Physical examination and ultrasound findings indicated breast development.The patient had recently started taking the oral medication Sacubitril/valsartan for the past two weeks and had no history of liver disease,endocrine disorders,or tumors,and also no history of hormonal or other specific medication use.Drug-induced male breast development due to Sacubitril/valsartan was initially suspected,and the medication was discontinued.After two weeks,the breast nodules decreased in size,and after one month,they com-pletely regressed,with remission in breast pain.Based on literature review and analysis,the final diagnosis was drug-in-duced gynecomastia caused by Sacubitril/valsartan.This case contributes to increasing awareness among healthcare pro-fessionals regarding the rare adverse reactions of Sacubitril/valsartan and further understanding its use in peritoneal dialy-sis patients with end-stage renal disease,which helps minimize the impact on patients'quality of life and prognosis and provides insights into the mechanism of this medicine.