慢性肾上腺皮质功能减退症临床分析.pdfVIP

2008 5 8 5 M odern H osp italM ay 2008 V ol 8 N o 5 吴妙琼 邝树均 谭晓军 CL IN ICA L A NA LY S IS O F CHRON IC A DRENOCORT ICA L HY PO FUNCT ION . W UM iaoq iong , K UAN G S huj un, TAN X iaoj un 分析近 5 年来原发性和继发性慢性肾上腺皮质功能减退症的 因诊断和替代治疗 情况 回顾性分析 2002 年 1月 ~ 2007 年 12 月 67例原发性和继发性慢性肾上腺皮质功能减退症的临 床资料, 并进行治疗追踪 原发性的主要 因是结核( 2687% ) 恶性肿瘤治疗后( 1642% ) 自身免 疫疾 ( 44 8% ) , 继发 因主要是各种原因长期应用糖皮质激素停药后 ( 373 1% ) 席汉氏综合征 ( 1493% ) 两者共有表现为精神差食欲减退容易疲乏体重减轻低血压贫血低钠血症低血糖原发 性者伴色素沉着, 高钾血症; 继发性者则皮肤颜色变浅, 常有伴有甲状腺和性腺激素水平低的表现, 无高钾血 症正规糖皮质激素替代治疗者占 2239% , 部分正规替代治疗者占 3433% , 不正规替代治疗者占 4 32 8% 近年来结核恶性肿瘤治疗后和长期应用糖皮质激素停药后成为最主要导致慢性肾上腺皮质功能减退 症的原因, 替代治疗很不理想 肾上腺皮质功能减退症 慢性 诊断 治疗 氢化可的松 A bstract O bj ective T o analyze the characteristics o pa thogen , diagnosis and replacem ent the rapy o chron ic pr mi a ry and secondary adrenocortica l hypo unction in the past ive years. M ethod s To rev iew and ana lyze the clin ica l data o 67 cases w ith chron ic adrenocortical hypo unc tion rom January 2002 to D ecem be r 2007, and trace the the rapy. R esu lts T he m a in pathogens o prmi ary case w ere tuberculosis ( 2687% ) , m alignant tum or ( 1642% ) , mi m uno log ica l diseases ( 448% ) ; the seconda ry w ere incorrect u se o corticoste ro ids long tmi e ( 373 1% ) , Sheehan! s syndrom e( 1493% ) . T he comm on eatu res w e re anorex ia, atigue, w eakness, w eigh t loss, hypotension, anem ia, hypona trem ia, hypog lycem ia, etc. The pr mi ary w as character ized by hyperp igmentation and hy perka lem ia. T he secondary has no hype rpigm entation and hyperka lem ia, but has hypo unction o thy ro id horm one and sex hormones. It w as 2239% o the pa tients to take regular therapy, 3433% w ere partly regular therapy, and 4328% w ere irregular therapy. Con clusion In recen t years, tubercu lo sis, m a lignan t tum or and incorrect u sing o co rticostero ids becam e ma in pathogens o chronic adr