慢性肾上腺皮质功能减退症临床分析

CLINICAL ANALYSIS OF CHRONIC ADRENOCORTICAL HYPOFUNCTION.

目的分析近5年来原发性和继发性慢性肾上腺皮质功能减退症的病因、诊断和替代治疗情况。方法回顾性分析2002年1月～2007年12月67例原发性和继发性慢性肾上腺皮质功能减退症的临床资料,并进行治疗追踪。结果原发性的主要病因是结核(26.87%)、恶性肿瘤治疗后(16.42%)、自身免疫疾病(4.48%),继发病因主要是各种原因长期应用糖皮质激素停药后(37.31%)、席汉氏综合征(14.93%)。两者共有表现为精神差、食欲减退、容易疲乏、体重减轻、低血压、贫血、低钠血症、低血糖。原发性者伴色素沉着,高钾血症;继发性者则皮肤颜色变浅,常有伴有甲状腺和性腺激素水平低的表现,无高钾血症。正规糖皮质激素替代治疗者占22.39%,部分正规替代治疗者占34.33%,不正规替代治疗者占43.28%。结论近年来结核、恶性肿瘤治疗后和长期应用糖皮质激素停药后成为最主要导致慢性肾上腺皮质功能减退症的原因,替代治疗很不理想。

Objective To analyze the characteristics of pathogen , diagnosis and replacement therapy of chronic primary and secondary adrenocortical hypofunction in the past five years. Methods To review and analyze the clinical data of 67 cases with chronic adrenocortical hypofunction from January 2002 to December 2007, and trace the therapy. Results The main pathogens of primary case were tuberculosis （26. 87% ） , malignant tumor （16. 42% ）, immunological diseases （4. 48% ）; the secondary were incorrect use of corticosteroids long time （37. 31% ） , Sheehan＇ s syndrome（ 14. 93% ）. The common features were anorexia, fatigue, weakness, weight loss, hypotension, anemia, hyponatremia, hypoglycemia, etc. The primary was characterized by hyperpigmentation and hyperkalemia. The secondary has no hyperpigmentation and hyperkalemia, but has hypofunction of thyroid hormone and sex hormones. It was 22. 39% of the patients to take regular therapy, 34. 33% were partly regular therapy, and 43.28% were irregular therapy. Conclusion In recent years, tuberculosis, malignant tumor and incorrect using of corticosteroids became main pathogens of chronic adrenocortical hypofunction, and mostly patients＇ therapy didn＇ t reach goal.