[施密特综合征患者的横纹肌溶解、低钠血症和发热]

Kordish I, Herrmann B L, Lahner H, Schroeder T, Janssen O E, Mann K

Klinik für Endokrinologie, Zentrum für Innere Medizin, Universitätsklinikum Essen.

Dtsch Med Wochenschr. 2003 Aug 1;128(31-32):1649-52. doi: 10.1055/s-2003-41100.

HISTORY

A 38-year-old man had fever (40 degrees C) and a swollen right leg. Two weeks before admission he had received non-steroid anti-inflammatory drugs (paracetamol and ibuprofen) after a tooth extraction. Some weeks before he had noticed a rough voice and a dry skin.

INVESTIGATIONS

The patient had a sinus tachycardia of 145/min (blood pressure of 130/80 mm Hg). Laboratory data revealed a CK of 16,650 U/l (< 80 U/l), myoglobin of 2420 U/l (< 90 microg/l) and LDH of 1250 U/l (<240 U/l), leukocyte count of 12,000 / microl and C-reactive protein of 3.0 mg/dl (<0.5 mg/dl). Sodium was markedly decreased (110 mmol/l (135 - 145 mmol/l)). Determination of thyroid hormone showed primary hypothyroidism with an elevated TSH of 62.6 mU/l (0.3 - 4.0 mU/l); T4 of 38 nmol/l (58 - 154 nmol/l), T3 1.17 of nmol/l (1.23 - 3.08 nmol/l) and fT4 of 6 pmol/l (10 - 25 pmol/l). The thyroid autoantibodies were increased (thyroxine peroxidase antibodies of 684 U/l (<35 U/l) and thyroglobulin antibodies of 173 U/l (<40 U/l)). Ultrasound of the thyroid revealed an nonhomogeneous structure. Cortisol at 8.00 a. m. was reduced by 63 mmol/l (180 - 640 mmol/l) and did not increase after administration of ACTH (60 min. cortisol at 90 mmol/l (>550 mmol/l)). ACTH was increased (141 pg/ml; normal range 17 - 52 pg/ml).

TREATMENT AND COURSE

The initial therapy consisted of hydrocortisone (100 mg i.v as bolus and 100 mg during the next 24 hours) and levothyroxine replacement (200 micro g) was initiated. During the following 8 days clinical symptoms regressed. Values of sodium, myoglobin and LDH decreased. After therapy with cephalosporin (Ceftriaxon) and penicillin (Flucloxacillin) fever and inflammation parameters decreased.

CONCLUSION

This is a rare case of a rhabdomyolysis and hyponatriaemia due to hypothyroidism and Addison's disease (Schmidt's syndrome).

病史

一名38岁男性，发热（40摄氏度），右腿肿胀。入院前两周拔牙后服用了非甾体类抗炎药（对乙酰氨基酚和布洛芬）。几周前他注意到声音沙哑和皮肤干燥。

检查

患者窦性心动过速，心率145次/分钟（血压130/80 mmHg）。实验室检查数据显示肌酸激酶（CK）为16,650 U/l（<80 U/l），肌红蛋白为2420 U/l（<90 μg/l），乳酸脱氢酶（LDH）为1250 U/l（<240 U/l），白细胞计数为12,000 / μl，C反应蛋白为3.0 mg/dl（<0.5 mg/dl）。钠明显降低（110 mmol/l（135 - 145 mmol/l））。甲状腺激素测定显示原发性甲状腺功能减退，促甲状腺激素（TSH）升高至62.6 mU/l（0.3 - 4.0 mU/l）；甲状腺素（T4）为38 nmol/l（58 - 154 nmol/l），三碘甲状腺原氨酸（T3）为1.17 nmol/l（1.23 - 3.08 nmol/l），游离甲状腺素（fT4）为6 pmol/l（10 - 25 pmol/l）。甲状腺自身抗体升高（甲状腺过氧化物酶抗体为684 U/l（<35 U/l），甲状腺球蛋白抗体为173 U/l（<40 U/l））。甲状腺超声显示结构不均匀。上午8点的皮质醇降低至63 mmol/l（180 - 640 mmol/l），注射促肾上腺皮质激素（ACTH）后未升高（90分钟时皮质醇为90 mmol/l（>550 mmol/l））。促肾上腺皮质激素升高（141 pg/ml；正常范围17 - 52 pg/ml）。