原发性肾上腺皮质功能减退症20例临床分析

Clinical analysis of 20 cases of primary adrenocortical insufficiency.

目的探讨原发性肾上腺皮质功能减退症的临床特点及诊疗措施。方法对20例原发性肾上腺皮质功能减退症患者的临床资料进行回顾性分析。结果20例患者中13例为结核性,5例为特发性,2例为肾上腺切除术后;临床表现中以皮肤色素沉着较特异;非特异性症状出现早,且较常见。确诊有赖于皮质醇测定及快速促肾上腺皮质激素兴奋试验,其他激素及生化指标也有改变。结核性患者肾上腺CT以增生、钙化为主要表现。结论确诊后给予泼尼松替代治疗,应激状态下应加大剂量,避免发生危象。

Objective To study the clinical features of primary adrenocortical insufficiency and its treatment.Methods Clinical data of 20 cases of primary adrenocortical insufficiency were retrospectively analyzed.Results There were 13 cases with tuberculous adrenalitis,5 with idiopathic adrenalitis and 2 adrenectomy.Characterized by hyperpigmentation of skin.Nonspecific symptoms presented earlier and were common.The confirmation of diagnosis was dependent on the corticotropin stimulation test and ACTH.Other hormone and biochemical indexes were slightly changed.Marked enlargement of the adrenal glands with or without calcifications in patients with tuberculous adrenal insufficiency was a sign of active infection.Conclusion Patients with primary adrenal insufficiency should be replaced with pronison and were added the high dose of pronison temporarily when they are at stress.