自身免疫性多内分泌腺综合征2型合并糖尿病急性并发症及甲亢危象一例并文献复习

Autoimmune polyendocrine syndrome type 2 complicated with hyperthyroidism crisis and diabetic acute complications:a case report and literature review

目的 提高临床医师对自身免疫性多内分泌腺综合征2型(APS-2)患者出现危重症并发症的诊治水平,减少漏诊和误诊。方法 报道1例出现多种内分泌腺危象的46岁APS-2女性患者,并以“自身免疫性多内分泌腺综合征”“糖尿病急性并发症”“甲状腺功能亢进危象(甲亢危象)”(包括中英文)为检索词,对以下数据库的相关论文进行检索:PubMed、中国生物医学文献服务系统(SinoMed)、CNKI、万方数据知识服务平台、维普中文科技期刊数据库。收集并分析检索到的APS患者中合并糖尿病急性并发症、甲亢危象者的资料。结果 该例患者反复多尿、多饮18年,以恶心、呕吐半日为主要表现入院。完善相关检查后提示患者存在糖尿病酮症酸中毒合并乳酸性酸中毒、甲亢危象,最终诊断为APS-2。文献仅检索到APS-3同时合并糖尿病急性并发症及甲亢危象的2例病例,未检索到APS-2或其他APS分型的同类病例。结论 APS-2同时并发糖尿病急性并发症及甲亢危象者罕见,易被漏诊而延误病情,临床医师应提高诊治水平,及早治疗有助于患者获得良好转归。

Objective To enhance clinicians’diagnosis and treatment capability for autoimmune polyendocrine syndrome type 2(APS-2),and reduce missed diagnosis and misdiagnosis.Methods A 46-year-old female APS-2 patient with polyendocrine crisis was reported.Using the key words of“autoimmune polyendocrine syndrome”“diabetic acute complications”and“hyperthyroidism crisis”,relevant literatures were searched from PubMed,SinoMed,CNKI,Wanfang Data and China Science and Technology Journal Database.Data of APS patients complicated with diabetic acute complications and hyperthyroidism crisis were collected and analyzed.Results The main manifestations of this patient were repeated polyuria and polydipsia for 18 years.She was admitted due to nausea and vomiting for half a day.Relevant examinations suggested the signs of diabetic ketoacidosis complicated with lactic acidosis and hyperthyroidism crisis,and the diagnosis of APS-2 was confirmed.Only 2 cases of APS-3 combined with acute diabetic complications and hyperthyroidism crisis were found in the literature,no APS-2 or other APS types patient complicated with diabetic acute complications and hyperthyroidism crisis was searched.Conclusions APS-2 patients complicated with diabetic acute complications and hyperthyroidism crisis are rare,which is likely to miss diagnosis and delay the diagnosis and treatment.Clinicians should improve relevant diagnosis and treatment capability.Prompt treatment contributes to favorable prognosis.