长期口服糖皮质激素致医源性库欣综合征合并性腺轴抑制1例

A Case of Iatrogenic Cushing’s Syndrome with Gonadal Axis Inhibition Caused by Long-Term Oral Glucocorticoids

1例16岁女性患者,以“双手关节肿痛9年,腰痛3年,加重2周”主诉入院。入院后查体,言语呈童音,生长发育迟缓,身高90 cm,体重80 kg,BMI 98 kg/m2,颜面皮肤菲薄,多血质面容,满月脸、水牛背、向心性肥胖,腹部皮肤可见明显宽大紫纹,双手近端指间关节肿痛,膝关节疼痛,未见明显肿胀,未见阴毛及腋毛,月经未来潮。追问病史患者诉9年前无明显诱因出现双手关节肿痛,遂就诊当地医院,考虑“类风湿性关节炎(幼儿型)”,开始口服“泼尼松片60 mg qd”1年,之后长期口服“泼尼松片10~15 mg qd”,2021年10月自行减至2.5 mg bid,维持此剂量至今。本患者出现明显的皮质醇增多的临床表现,同时性腺轴明显受抑制。临床中准确应用糖皮质激素尤为重要,特别是对于初始治疗的儿童及青少年,谨防医源性药物不良反应的出现,尽量避免此类事情的发生。

A 16-year-old female patient was admitted to the hospital with the chief complaint of “joint swelling and pain in both hands for 9 years, low back pain for 3 years, and aggravation for 2 weeks”. On physical examination after admission, her speech was childlike, her growth was retarded, her height was 90 cm, her weight was 80 kg. BMI 98 kg/m2, thin facial skin, bloody face, full moon face, buffalo back, centripetal obesity, abdominal skin visible wide purple lines, hands proximal inter-phalangeal joint swelling and pain, knee pain, no obvious swelling, no pubic hair and armpit hair, menstruation in the future. The patient complained of joint swelling and pain in both hands without obvious inducement 9 years ago, so she went to the local hospital and considered “rheumatoid ar-thritis (infant type)”. She began to take “prednisone tablets 60 mg qd” for 1 year, and then took “prednisone tablets 10~15 mg qd” for a long time, which was reduced to 2.5 mg bid by herself in October 2021, maintain this dose to date. The patient presented with a marked increase in cortisol and a marked inhibition of the gonadal axis. Accurate application of glucocorticoids is particularly important in clinical practice, especially for children and adolescents with initial treatment, to pre-vent the occurrence of iatrogenic adverse drug reactions and try to avoid such things.