肾上腺结核致Addison病26例临床分析

Addison's disease caused by adrenal tuberculosis in 26 cases

目的总结肾上腺结核致Addison病的临床特征。方法回顾性分析26例肾上腺结核致Addison病患者的临床资料。结果 26例肾上腺结核均经CT引导下穿刺活检组织病理证实;临床主要表现为皮肤色素沉着26例,疲乏无力25例,纳差、恶心23例;实验室检查示促肾上腺皮质激素升高26例,电解质紊乱(低钠、高钾)7例,血沉增快9例,T淋巴细胞斑点试验阳性10例;CT示双侧肾上腺增大26例;经纠正低血容量、电解质紊乱等对症治疗,抗结核治疗联合糖皮质激素替代治疗,均好转出院。结论肾上腺结核致Addison病临床表现多样,实验室结果和影像学表现缺乏特异性,确诊需依据病理检查,经积极治疗患者预后良好。

Objective To analyze the clinical characteristics of Addison＇s disease caused by adrenal tuberculosis.Methods The clinical data of 26 cases of Addison＇s disease caused by adrenal tuberculosis were retrospectively analyzed.Results All 26 cases of adrenal tuberculosis were histopathologically confirmed by CT guided biopsy,clinically demonstrated by skin pigmentation in 26 cases,fatigue and weakness in 25 and nausea in 23.The laboratory test showed high adrenocorticotrophic hormone in 26 cases,hyponatremia and hyperkalemia in 7,increase of erythrocyte sedimentation rate in 9,and positive T-SPOT-TB in 10.CT demonstrated bilateral adrenal masses in 26 cases.All patients were discharged after symptomatic treatment as correcting hypovolemia and electrolyte disturbances,as well as antitubercular therapy combined with glucocorticoid replacement.Conclusion Since Addison＇s disease caused by adrenal tuberculosis varies in clinical presentations,the laboratory and imaging scan lack the specificity.The diagnosis depends on the pathological result.The prognosis is good after active treatment.