食管癌术后肾上腺危象1例并文献复习  

A Case of Adrenal Crisis after Esophageal Cancer Surgery and Literature Review

作　　者：贺小旭[1] 李周平 刘音[1] 饶芝国[1] 薛晓艳[1] HE Xiao-xu;LI Zhou-ping;LIU Yin;RAO Zhi-guo;XUE Xiao-yan(Department of Intensive Medicine,A erospace Center Hospital,Beijing 100049,China)

机构地区：[1]航天中心医院重症医学科,北京100049

出　　处：《中国合理用药探索》2024年第1期40-44,共5页Chinese Journal of Rational Drug Use

摘　　要：目的:探讨肾上腺危象(AC)的临床特征及诊疗要点,减少临床工作中的漏诊、误诊、误治。方法:回顾性分析1例食管癌术后合并AC的临床资料,总结AC的临床诊治经过。结果:患者为49岁男性,因食管癌术后3周出现发热入院,存在吻合口瘘,给予多种抗菌药物长时间抗感染治疗效果不佳,即使瘘口愈合后仍间断高热、血压下降。患者偶用激素退热治疗后效果较好,但减量停用后患者逐渐乏力、卧床。查增强计算机断层扫描(CT)未见肿瘤复发,皮质醇、促肾上腺皮质激素(ACTH)明显偏低,结合术前曾应用程序性死亡受体1(PD-1)抑制剂,明确诊断为免疫治疗相关垂体炎,进而导致了AC,补充醋酸泼尼松片后好转出院。结论:AC是一种危急的内科急症,临床表现缺乏特异性,极容易漏诊、误诊、误治,临床医生应加强对本病的认识,从而达到早期诊断并能及时给予糖皮质激素治疗的目的。Objective:To explore the clinical features and main points of diagnosis and treatment about adrenal crisis(AC),so as to reduce the missed diagnosis,misdiagnosis and wrong treatment in the clinical work.Methods:The clinical data of one patient with AC following esophageal cancer surgery were analyzed retrospectively,and the process of clinical diagnosis and treatment of AC were summarized.Results:A 49-year-old male patient was admitted due to fever 3 weeks after esophageal cancer surgery,identified with anastomotic leakage,and treated with multiple antibiotics which showed poor anti-infection effect over a long period of time.Moreover,the patient experienced intermittent high fever and decreased blood pressure even after the fistula healing,responded well to the hormone with defervescence,while was gradually fatigue and bedridden after dose reduction and discontinuation.No evidence of tumor recurrence was found by the enhanced computed tomography(CT)with contrast,while significantly decreased levels of cortisol and adrenocorticotropic hormone(ACTH)were revealed in the laboratory test.The patient was diagnosed with the immunotherapy-related hypophysitis,which led to AC,based on the pre-operative application of programmed death receptor 1(PD-1)inhibitors,and was discharged upon improvement with supplementary prednisone.Conclusion:As a critical internal medical condition,AC has non-specific clinical manifestations and is very easily vulnerable to missed diagnosis,misdiagnosis and wrong treatment,thus should be emphasized for clinicians to increase their understanding so as to achieve early diagnosis and timely treatment with glucocorticoid.

关 键 词：肾上腺危象 急性肾上腺皮质功能不全 脓毒症 促肾上腺皮质激素 程序性死亡受体1 

分 类 号：R736.6[医药卫生—肿瘤]