曲安奈德外用制剂致医源性库欣综合征1例

One case of iatrogenic Cushing syndrome induced by external preparation of triamcinolone acetonide

1例67岁女性患者,因颜面部、眼睑浮肿半年余入院。患者10年前因反复皮疹,未间断使用曲安奈德外用制剂至今,半年前发现血压升高,最高180/90 mm Hg(1 mm Hg=0.133 k Pa),本次入院患者有满月脸、锁骨上脂肪垫,腹型肥胖,毳毛增多等肾上腺皮质醇增多表现,骨密度检查提示骨质疏松。完善检查后排除内源性库欣综合征,结合患者长期外用曲安奈德制剂的用药史,停药后有乏力、纳差等皮质醇功能低下表现,考虑曲安奈德导致医源性库欣综合征。立即停用曲安奈德,给予降压、抗骨质疏松等对症治疗,出院2个月后,患者肾上腺皮质醇增多症状明显缓解。

One 67-year-old female patient was admitted to hospital because of facial and eyelid edema for more than half a year.She had been used external preparation of triamcinolone acetonide for more than 10 years because of repeated rashes.Half a year ago,her blood pressure was found to be up to 180/90 mm Hg(1 mm Hg=0.133 kPa).After admission,she showed classical symptoms of excessive glucocorticoid such as a moon face,dorsocervical and supraclavicular fat pads,central obesity,hirsutism,etc.Result of bone density test showed osteoprosis.Based on history of using triamcinolone acetonide for a long time,clinical manifestations of adrenal insufficiency like weakness and anorexia after withdrawal of triamcinolone acetonide,iatrogenic Cushing syndrome caused by triamcinolone acetonide was considered rather than spontaneous Cushing syndrome.And then triamcinolone acetonide was stopped immediately and systematic treatment including antihypertensive and anti-osteoporosis drugs were given to her at the same time.2 months after discharging from hospital,her symptoms of excessive glucocorticoid significantly relieved.