误诊为急性心肌梗死的异位促肾上腺皮质激素综合征1例报道

Ectopic adrenocorticotropic hormone syndrome diagnosed as acute myocardial infarction:A case report and literature review

目的探讨以心肌损伤为首发表现的异位促肾上腺皮质激素(adrenocorticotropic hormone,ACTH)综合征的发病机制、临床表现及诊断思路。方法分析解放军总医院心内科收治的1例以急性心肌梗死为首发诊断的异位ACTH综合征患者的临床表现、实验室及影像检查与临床诊疗思路。结果患者老年女性,在外院因心肌酶升高、心电图ST-T改变及临床症状诊断为急性非ST段抬高型心肌梗死,入院后针对顽固性低钾低钠低氯血症展开进一步的检查诊断,发现胰头占位、肝多发占位,肾上腺增生及ACTH严重升高,诊断为异位ACTH综合征。结论诊断为急性心肌梗死患者,如发现合并顽固性低钾低钠血症,注意鉴别异位ACTH综合征可能,尽可能做到早期诊断。

Objective To study the mechanism, clinical manifestation and diagnostic strategy of ectopic adrenocorticotropic hormone （ACTH） syndrome who was diagnosed as acute myocardial infraction firstly. Methods Clinical manifestation, laboratory and imaging examination, differential diagnostic strategy of a patient with ectopic ACTH syndrome were analyzed. Results The case was diagnosed as non-ST elevated myocardial infarction （NSTEMI） in other hospital by analyzing the patient＇s （an aged woman） elevated cardiac enzyme, ECG ST-T changes and clinical symptoms. In our hospital, we found that ACTH elevated severely, and adrenal hyperplasia, pancreas occupying lesion, and multiple metastasis in liver through further diagnosis. Conclusion The EAS should be differential diagnosed in patients with AMI complicated with electrolyte disturbances, which should be diagnosed early.