腺垂体功能减退症误诊为胃肠炎1例  

Misdiagnosis of hypopituitarism as gastroenteritis:A case report

作　　者：段盛蕾 杜林柯 郑烈 Sheng-Lei Duan;Lin-Ke Du;Lie Zheng(Shaanxi Provincial Hospital of Traditional Chinese Medicine,Xi’an 710003,Shaanxi Province,China)

机构地区：[1]陕西省中医医院,陕西省西安市710003

出　　处：《世界华人消化杂志》2023年第22期949-952,共4页World Chinese Journal of Digestology

基　　金：西安市科技局计划项目,No.23YXYJ0162;陕西省中医医院“苗圃培优”计划项目,No.2021-07;陕西省自然科学基础研究计划一般项目,No.2019JM-580(面上);陕西省中医药管理局科研项目,No.2019-ZZ-JC010;陕西省中医医院院级课题,No.2018-04和No.2021-07.

摘　　要：背景腺垂体功能减退临床表现不典型,复杂多样,易造成误诊.病例简介患者,男,72岁,因“间断腹泻10年余”入院,既往诊断为胃肠炎,口服“氟哌酸、思密达”等疗效欠佳,住院期间出现反应迟钝、嗜睡、对答不切题等精神症状,查甲状腺激素水平、性激素水平、皮质醇水平均明显降低,脑垂体MR显示空泡蝶鞍、垂体受压,诊断为腺垂体功能减退,给予激素治疗后患者神志恢复正常,腹泻消失.结论腺垂体功能减退临床表现不典型,复杂多样,易出现漏诊及误诊,若诊治不及时可出现垂体危象,危及生命.在临床中腺垂体功能减退症并不少见,对于皮肤干燥苍白、弹性差或浮肿、贫血、纳差、便秘、毛发脱落、畏冷、表情淡漠、音调低沉、反应迟钝、虚弱无力、食欲减退、恶心、呕吐、体重减轻、心率缓慢、心音低钝、血压下降、低血糖等表现的患者要考虑是否存在腺垂体功能减退症.BACKGROUND The clinical manifestations of pituitary dysfunction are atypical,complex,and diverse,which can easily lead to misdiagnosis.CASE SUMMARY A 72-years-old male patient was admitted to the hospital due to“intermittent diarrhea for more than 10 years”.He has previously been diagnosed with gastroenteritis,and the efficacy of oral administration of“norfloxacin and smecta”was not satisfactory.During hospitalization,he had mental symptoms such as delayed response,drowsiness,and difficulty answering questions.Upon examination,thyroid hormone levels,sex hormone levels,and cortisol levels were significantly reduced.Pituitary magnetic resonance imaging showed empty sella and pituitary compression,indicating hypopituitarism.After receiving glucocorticoid treatment,the patient’s consciousness returned to normal and his diarrhea disappeared.CONCLUSION The clinical manifestations of hypopituitarism are atypical,complex,and diverse,which makes it prone to misdiagnosis and missed diagnosis.If not diagnosed and treated in a timely manner,pituitary crisis may occur,endangering patients’life.Hypofunction of the pituitary gland is not uncommon in clinical practice.For patients with dry and pale skin,poor elasticity or swelling,anemia,anorexia,constipation,hair loss,fear of cold,indifferent expression,low pitch,slow response,weakness,loss of appetite,nausea,vomiting,weight loss,slow heart rate,low heart sound,decreased blood pressure,hypoglycemia,etc.,hypofunction of the pituitary gland should be considered.

关 键 词：腺垂体功能减退症 胃肠炎 误诊 

分 类 号：R57[医药卫生—消化系统]