肺结核并肾上腺结核致肾上腺危象一例并文献复习  

Adrenal Crisis Induced by Tuberculosis and Adrenal Tuberculosis: A Case Report and Literature Review

作　　者：赵睿[1] 谢加利[1] 常小红[1] 

机构地区：[1]延安大学附属医院呼吸内科,陕西延安716000

出　　处：《临床误诊误治》2014年第4期4-6,共3页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨肺结核并肾上腺结核致肾上腺危象的临床特点,减少误诊误治。方法回顾分析1例肺结核继发肾上腺结核致肾上腺危象的临床资料,并复习相关文献。结果本例以咳嗽、气短、盗汗、乏力、全身色素沉着和严重低钠、低氯血症为主要表现就诊,外院诊断为双肺结核、右肾上腺瘤。入我院后经相关检查诊断为菌阴肺结核,经相应治疗无好转,进一步经皮质醇节律测定确诊为肺结核并肾上腺结核,肾上腺危象。予抗结核治疗及糖皮质激素替代治疗,病情改善。4个月后随访,病情明显好转,仍在治疗中。结论对于结核病并肾上腺占位性病变患者,应注意鉴别肺结核与肾上腺结核是否并存,尤其要警惕是否并发原发性肾上腺皮质功能减退症的可能。Objective To investigate clinical features of adrenal crisis induced by tuberculosis （TB） and adrenal tu- berculosis so as to reduce misdiagnosis rate. Methods Clinical data of 1 patient with adrenal crisis induced by TB and adre- nal crisis was retrospectively analyzed, and relevant literature was reviewed. Results The patient visited doctors for cough, short breath, night sweats, acratia, pigmentation of the whole body, severe low sodium and hypochloraemia, and double TB and right adrenal tumor were diagnosed in other hospitals. Negative pulmonary tuberculosis was diagnosed by relevant medical examinations after admission to our hospital, but the symptom was not improved after corresponding therapy, and pulmonary tuberculosis complicated by adrenal tuberculosis and adrenal crisis was confirmed after determination of cortisol rhythm. The patient＇s condition was improved after anti-tuberculosis treatment. The symptom was obviously improved by follow-up four months later, and the patients were still in treatment. Conclusion Clinicians should pay close attention to identifying whether TB is complicated by adrenal tuberculosis or not, especially to complication of primary adrenocortical insufficiency for patients with TB and adrenal placeholder.

关 键 词：肺结核 肾上腺疾病 肾上腺皮质疾病 误诊 肾肿瘤 

分 类 号：R529.0[医药卫生—内科学]