16例肾上腺结核的临床分析

Clinical analysis of 16 cases of adrenal tuberculosis

目的:探讨肾上腺结核患者的临床特征,以期提高临床医师对肾上腺结核的认知。方法:收集我院自2003年1月1日至2013年12月31日临床诊断为肾上腺结核的16例患者,对其临床表现、影像学检查及治疗进行分析。结果:15例(88%)患者有肾上腺皮质功能减退症状,如皮肤黏膜颜色加深伴色素沉着(14例),纳差、消瘦(12例),乏力、易疲劳(12例),性欲减退及性功能下降(3例)等。肾上腺结核CT表现为肾上腺增粗(14例)或缩小(1例)、病灶内出现斑片样钙化影(7例),病灶可强化(11例)。诊断后行抗结核及激素治疗等对症治疗,临床症状得到改善,但促肾上腺皮质激素(ACTH)[(1 286.0±947.7)ng/L]、血氢化可的松[(70.27±26.40)μg/L]及24 h尿氢化可的松[(311.88±243.13)μg/24 h]未得以恢复。1例患者表现为肾上腺脓肿,经手术治疗后痊愈。结论:肾上腺结核可引起肾上腺分泌功能紊乱,可根据CT表现进行初步诊断,规律抗结核辅以激素治疗等对症治疗可以改善临床症状,不能改善肾上腺功能。

Objective For improving the recognition and diagnosis of adrenal tuberculosis,the clinical characteristic and adrenal image of the disease were analyzed. Methods Sixteen cases of adrenal tuberculosis diagnosed and treated from January 1,2003 to December 31,2013 were enrolled in this study. The clinical manifestations,results of imaging examination,and treatment were analyzed. Results The majority of patients（88%,15/16 cases） had the manifestations of adrenal hypofunction,such as hyperpigmentation of skin and buccal mucosa（14 cases）,decreased appetite and weight loss（12 cases）,fatigue（3 cases）,decreased libido and decline of sexual function（3 cases）. CT scan of abdomen showed adrenal gland enlargement（14 cases） or narrowing（1 case）. Some of the cases revealed calcification in adrenal gland（7 cases）and enhancement in contrast-enhanced CT scan images（11 cases）. Treated with anti-tuberculosis drugs and appropriate steroid replacement therapy could improve the clinical symptoms,yet the adrenocortical function manifested as levels of adrenocorticotropic hormone（ACTH） [（1 286.0±947.7） ng/L],serum cortisol [（70.27±26.40） μg/L] and 24 h urine cortisol[（311.88±243.13） μg/24 h] had not recovered. Adrenal tuberculosis was presented as abscess of the adrenal gland in 1 case and symptoms was improved after surgical operation. Conclusions Adrenal tuberculosis could cause the dysfunction of adrenal gland. Preliminary diagnosis could be made via CT scan image. Treatment with anti-tuberculosis drugs and appropriate steroid replacement therapy could relieve clinical symptoms,yet could not improve the function of adrenal gland.