肾上腺皮质癌误诊一例并文献复习  

Misdiagnosis of Adrenocortical Carcinoma:a Case Report and Literature Review

作　　者：喻昆林[1] 徐勇辉[2] 

机构地区：[1]昆明医科大学第二附属医院内分泌科,昆明650101 [2]昆明医科大学第二附属医院放射科,昆明650101

出　　处：《临床误诊误治》2017年第7期28-31,共4页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨肾上腺皮质癌(adrenocortical carcinoma,ACC)的临床特点及诊断方法,以减少临床误诊误治。方法回顾分析1例ACC误诊病例资料,并复习相关文献。结果本例为28岁女性,因体重增加、闭经1年,双下肢水肿、乏力3个月入院。在当地医院诊断为糖尿病、高血压病,予对症治疗无效转我院内分泌科,初诊为皮质醇增多症、肝脏占位性病变。入院后查血皮质醇水平明显升高,醛固酮轻度升高,性激素水平异常;胸腹部CT检查示:腹膜后(右肾上腺)巨大占位性病变并肝内转移,门脉右支及下腔静脉癌栓形成,双肺多发转移结节,肋骨多发骨折。明确诊断为右肾上腺皮质癌并全身广泛转移;继发性糖尿病、高血压病。因肿瘤巨大并发全身多处转移,无法进行手术治疗,患者在血糖、血压控制平稳后自行出院,后失访。结论 ACC临床罕见,易发生转移,临床表现多样。掌握该病临床特点,综合分析病情,及时行相关的内分泌激素测定及肾上腺影像学检查,有助于避免误诊。Objective To investigate clinical characteristics and diagnostic methods of adrenocortical carcinoma （ACC） in order to avoid misdiagnosis and mistreatment. Methods Clinical data of a misdiagnosed patient with ACC was ret-rospectively analyzed, and related literature was reviewed. Results The 28-year-old female was admitted for weight gain and amenorrhea for 1 year, edema in both lower extremities and weakness for three months. In the local hospital the patient was diagnosed as having diabetes, hypertension and invalid treatment, and was transferred to our endocrinology department, and the primary diagnosis was hypercortisolism and space occupying lesions in liver. After admission, examinations showed that blood cortisol levels were significantly increased, aldosterone levels were slightly increased and sex hormone levels were abnormal. Thoracic and abdominal CT showed retroperitoneal （right adrenal gland） massive space occupying lesions and metastasis in liver, tumor thrombus formation in right branch of portal vein and inferior vena cava, multiple metastatic nodules of double lungs and multiple rib fractures. The definitive diagnosis was right adrenal cortical carcinoma associated by extensive metasta- sis of the whole body, secondary diabetes and hypertension. Because of the huge tumor, metastasis of the whole body, surgical treatment was impossible. After controlling blood sugar and blood pressure, the patient discharged from hospital by herself with losing follow-up. Conclusion ACC is rare, and it is easy to metastasize with diverse manifestations in clinic. Mastering clinical features, analyzing the condition comprehensively, and performing the relevant endocrine hormone test and imaging exami- nation in time are helpful to avoid misdiagnosis.

关 键 词：肾上腺皮质肿瘤 误诊 皮质醇增多症 

分 类 号：R736.6[医药卫生—肿瘤]