以严重低血钾为主要表现的异位促肾上腺皮质激素综合征1例

A case of ectopic adrenocorticotropic hormone syndrome characterized by severe hypokalemia

库欣综合征作为临床少见病,症状多系统多样化,许多患者在确诊前均因其他系统表现至非专科就诊,或者因症状不明显未就诊,极易导致心肾、血管等多组织脏器的损害。异位促肾上腺皮质激素(adrenocorticotropic hormone,ACTH)综合征作为库欣综合征的病因之一,发病率更低,病灶更隐匿,因为皮质醇水平更高,对糖脂、蛋白等代谢方面产生很大危害,与其他病因相比,恶性疾病更多见,预后不佳。早发现、早诊断、早治疗能明显改善患者病情。本文中为一年轻患者,病程较长但自身未重视,首次就诊也未引起医生关注,导致患者出现严重的低钾。现就从全科角度对该病例诊疗进行分析,并进行相关文献复习,提高基层医生对相关疾病的敏感性,拓展临床思路,指导患者在体重、皮肤等方面出现变化时及时就诊,排除病理性因素,做好健康宣教。

Cushing's syndrome,as a rare clinical disease,has diverse symptoms of multiple systems.Many patients go to non-specialist due to other system manifestations before diagnosis,or fail to see a doctor due to unconspicuous symptoms,which is very easy to cause damages to heart,kidney,vessels and other tissues and organs.Ectopic adrenocorticotropic hormone(ACTH)syndrome,as one of the causes of Cushing's syndrome,has a lower incidence and more hidden lesions.Because of the higher level of cortisol,it has a great harm to the metabolism of glycolipids,proteins and so on.Compared with other causes,malignant diseases are more common and the prognosis is poor.Early detection,early diagnosis and early treatment can significantly improve the patient's condition.This is a young patient with a long course of disease,but he did not pay attention to it.The first visit did not attract the attention of doctors,resulting in severe hypokalemia.This paper analyzes the diagnosis and treatment of this case from the perspective of general practice,and reviews the relevant literature,so as to improve the sensitivity of grass-roots doctors to related diseases,expand clinical thinking,guide patients to see a doctor in time when there are changes in weight,skin and other aspects,eliminate pathological factors,and do a good job in health education.