Wake Mikiko, Sanagawa Yumi, Tanaka Yoko
Department of Anesthesia, Himeji St. Mary's Hospital, Himeji 670-0801.
Masui. 2002 Jun;51(6):648-51.
We report a case of ACTH deficiency. A 75-year-old man complained of anoxia, nausea and vomiting. Three years ago, he had an attack of loss of consciousness. On admission, his serum sodium level was down to 119.6 mEq.l-1. Plasma osmolality was low and urinary osmolality was high without edema, and he was diagnosed as having SIADH. After CRH test, rapid ACTH test and continuous ACTH test, he was diagnosed as having ACTH deficiency, and he was treated with steroids. One year later, he received urethrotomy due to urethrostenosis under spinal anesthesia with no trouble. In the next year, he was scheduled for sigmoidectomy due to sigmoid colon cancer under general anesthesia combined with epidural anesthesia. In the morning of his operation, he took hydrocortisone 10 mg per os. During operation, hydrocortisone 300 mg was given intravenously divided for three times. Plasma ACTH and aldosterone levels were below normal ranges, but serum cortisol was above the normal range. His operation was finished without troubles. Regarding this case, we discussed steroid therapy during anesthesia and operation.
我们报告一例促肾上腺皮质激素（ACTH）缺乏症病例。一名75岁男性主诉缺氧、恶心和呕吐。三年前，他曾发生过一次意识丧失发作。入院时，他的血清钠水平降至119.6 mEq·l⁻¹。血浆渗透压降低，尿渗透压升高，且无水肿，他被诊断为抗利尿激素分泌失调综合征（SIADH）。经过促肾上腺皮质激素释放激素（CRH）试验、快速ACTH试验和连续ACTH试验后，他被诊断为ACTH缺乏症，并接受了类固醇治疗。一年后，他在脊髓麻醉下行尿道切开术治疗尿道狭窄，过程顺利。次年，他因乙状结肠癌计划在全身麻醉联合硬膜外麻醉下行乙状结肠切除术。手术当天上午，他口服了10毫克氢化可的松。手术期间，静脉分次给予300毫克氢化可的松。血浆ACTH和醛固酮水平低于正常范围，但血清皮质醇高于正常范围。他的手术顺利完成。关于该病例，我们讨论了麻醉和手术期间的类固醇治疗。
