van Steijn J H M, Gans R O B
Academisch Ziekenhuis, afd. Interne Geneeskunde, Postbus 30.001, 9700 RB Groningen.
Ned Tijdschr Geneeskd. 2002 Mar 2;146(9):404-10.
An 88-year-old man presented with nausea and vomiting. Recently a cutaneous B-cell lymphoma had been diagnosed on his right cheek. Laboratory investigation showed hyponatraemia. Fluid restriction was started, based on the diagnosis of the syndrome of inappropriate antidiuretic hormone secretion (SIADH). However the hyponatraemia persisted and a diagnosis of 'reset osmostat' was made. CT of the abdomen revealed slight bilateral adrenal enlargement, which was interpreted as adrenal incidentaloma. No other localisation of the lymphoma, besides that on the right cheek, was seen. Although the symptoms initially disappeared, they recurred and were quickly followed by hypotension. The patient died. Post-mortem examination showed bilateral destruction of the adrenal glands due to lymphoma. The correct diagnosis was Addison's disease. This case shows that diseases do not always present with all the classical symptoms, and that it is important to consider test characteristics of diagnostic tests and to judge investigations in the context of the other clinical findings.
一名88岁男性出现恶心和呕吐症状。近期其右侧脸颊被诊断出皮肤B细胞淋巴瘤。实验室检查显示低钠血症。基于抗利尿激素分泌不当综合征（SIADH）的诊断，开始限制液体摄入。然而，低钠血症持续存在，随后诊断为“渗透压调定点重置”。腹部CT显示双侧肾上腺轻度增大，这被解释为肾上腺偶发瘤。除右侧脸颊的淋巴瘤外，未发现淋巴瘤的其他定位。尽管症状最初消失，但后来复发并很快出现低血压。患者死亡。尸检显示双侧肾上腺因淋巴瘤而遭到破坏。正确诊断为艾迪生病。该病例表明，疾病并不总是呈现出所有典型症状，并且考虑诊断检查的测试特征以及结合其他临床发现来判断检查结果非常重要。
