流行性出血热后迟发性腺垂体功能减退并垂体危象一例
Journal: Basic Medical Theory Research DOI: 10.32629/bmtr.v8i3.20437
Abstract
目的：提高肾病综合征出血热远期迟发性腺垂体功能减退及垂体危象的临床识别与诊治水平。方法：回顾性分析 1 例 53 岁男性出血热后迟发性全腺垂体功能减退并垂体危象患者的临床资料、实验室检查、影像学特征及诊疗经过，并结合文献复习。结果：患者 20 余年前确诊肾综合征出血热，病后长期体质偏弱。本次以头晕、呕吐 10 d 入院，进行性加重并出现精神行为异常；查体见颜面水肿、眉毛稀疏、腋毛阴毛脱落、乳晕色浅、舌体肥厚伴齿痕、共济不稳；辅助检查示严重低钠血症、低血糖、多浆膜腔积液、心肌酶显著升高、凝血功能异常；垂体靶腺激素示促肾上腺皮质激素（ACTH）显著降低、皮质醇昼夜节律消失，性激素及泌乳素水平极度低下；垂体 MRI 示空泡蝶鞍。确诊为腺垂体功能减退症、垂体危象、空泡蝶鞍综合征。予静脉氢化可的松抢救后继以泼尼松生理节律口服替代治疗，电解质、血糖、心肌酶、凝血功能迅速恢复正常，临床症状显著改善。结论：肾综合征出血热可致远期迟发性腺垂体坏死、空泡蝶鞍及全垂体功能减退，在应激状态下可诱发垂体危象，临床表现复杂易误诊；早期识别垂体功能减退线索并及时糖皮质激素替代治疗，预后良好。
Keywords
肾综合征出血热；腺垂体功能减退；垂体危象；空泡蝶鞍；低钠血症；低血糖
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[4] 黄长形,姜泓,白雪帆,等.肾综合征出血热诊疗陕西省专家共识[J].陕西医学杂志,2019,48(3):275-288.
[5] 中华医学会内分泌学分会.腺垂体功能减退症诊治指南[J].中华内分泌代谢杂志,2020,36(8):671-687.
[6] Molitch ME, Clemmons DR, Cook D, et al. Evaluation and treatment of adult hypopituitarism: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab, 2022, 107 (9):2413-2444.
[7] 李禹兵,高凌.垂体危象的诊治总结与回顾[J].内科急危重症杂志,2017,23(4):265-268.
[8] De Marinis L, Bonadonna S, Bianchi A, et al. Primary empty sella. J Clin Endocrinol Metab, 2005, 90 (9):5471-5477.
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[10] Suh DC, Park JS, Park SK, et al. Pituitary hemorrhage as a complication of hantaviral disease. AJNR Am J Neuroradiol, 1995, 16 (1):175-178.
[11] 黄芝.肾综合征出血热致腺垂体功能减退症1例报告[J].安徽医学,2011,32(5):697.
[12] 熊良圣,祝金泉.流行性出血热导致垂体前叶功能减退一例报告[J].实用临床医学,2006,7(1):60.
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