以反复呕吐为首发表现的肾上腺皮质功能减退症一例报道及文献复习

Clinical analysis and literature review on repeated recurrent vomiting as the starting performance of adrenocortical hypofunction disease

目的探讨非典型慢性肾上腺皮质功能减退的临床特点和误诊、误治原因。方法分析1例非典型肾上腺皮质功能减退病例的临床过程及实验室改变,并进行文献复习。结果慢性肾上腺皮质功能减退(Addison's病)临床表现隐匿,尤其早期症状不典型,遇应激易产生肾上腺危象,抢救不当可威胁生命。低钠血症病因复杂,易造成误诊、误治。结论反复出现与临床过程不相符的低钠血症时,应提高对肾上腺皮质功能减退的警惕,病史追踪和皮质醇检测及肾上腺CT检查可减少误诊。

Objective We aimed to discover the clinical characteristics of Atypical Chronic Addison＇s, and explore the reasons for misdiagnosis of this disease. Methods The clinical course and laboratory changes of Atypical Chronic Addison＇s cases were analyzed, and related literature was reviewed. Results Chronic Addison＇s is often ignored because of clinical latent, especially for its atypical symptoms at early stage. Adrenocortical crisis can be easily stimulated by stress, and can be life threatening without proper rescue methods. In this case, clinical features of atypical Chronic Addison＇s was not noticed even after the patient was hospitalized several times and took two adrenal gland CTs, and was finally confirmed after effective diagnostic therapy. Hyponatremia can be easily misdiagnosed because of its complicated etiology, which is adrenal tuberculosis and usually covered by irrelevant superficial phenomenon. Conclusion Recurring hyponatremia inconsistent with clinical process should be given a warning to raise the vigilance on Addison＇s; history tracking, adrenal cortisol detection, and CT examination can help reduce misdiagnosis.