库欣病误诊为原发性醛固酮增多症一例报告并文献复习

Cushing's Disease Misdiagnosed as Primary Aldosteronism: A Case Report and Literature Review

目的加强对无典型库欣综合征外貌的库欣病的认识,提高早期诊断水平,减少误漏诊,降低病死率。方法回顾分析我院2013年收治的1例误诊为原发性醛固酮增多症(原醛症)的库欣病的诊治经过及误诊原因,并复习相关文献。结果本例表现为高血压、严重低血钾,无典型库欣综合征外貌,曾在外院误诊为原醛症,予口服螺内酯、补钾等治疗效果差。在我院行小剂量及大剂量地塞米松抑制试验、垂体MR+动态增强扫描,并行双侧岩下窦采血检测促肾上腺皮质激素(ACTH)确诊为库欣病。行左侧垂体微腺瘤摘除术后复查电解质、皮质醇、ACTH正常。结论有高血压、低血钾但无典型库欣综合征外貌应考虑到库欣病的可能,及时完善相关检查,早诊断、早治疗,能有效改善症状及预后。

Objective To strengthen the understanding of atypical Cushing syndrome manifestations in Cushing dis-ease in order to improve the early diagnosis, reduce misdiagnosis or missed diagnosis and the mortality rates. Methods Clin-ical data of one patient with Cushing disease,who was admitted to our hospital in 2013 and misdiagnosed as having primary al-dosteronism, was retrospectively analyzed,and the related literature was reviewed. Results This patient with atypical Cushing syndrome manifestations, who suffered from hypertension and severe low blood potassium, was misdiagnosed as having primary aldosteronism. However the symptom did not improve after oral spironolactone and potassium. After inhibition test of small dose and large dose of dexamethasone, dynamic contrast-enhanced MRI appearances of pituitary, testing adrenocortical hor-mone（ACTH） by bilateral inferior petrosal sinus sampling （ BIPSS） in our hospital, this patient was diagnosed as having Cushing＇s disease. The levels of electrolyte, cortisol and ACTH returned to normal after left pituitary micro-adenoma enuclea-tion operation. Conclusion Clinicians should pay close attention to identifying atypical Cushing syndrome manifestations in Cushing disease patients who suffer from hypertension and severe low blood potassium and need to do relevant medical exami-nations in order to make early diagnosis and have early treatment, which will help to improve the prognosis of these patients.