Hubay C A, Weckesser E C, Levy R P
Ann Surg. 1975 Mar;181(3):325-32. doi: 10.1097/00000658-197503000-00014.
Eight patients admitted to a University hospital with acute surgical problems and related adrenal insufficiency were reviewed and three are presented in detail. Surgical stress and continued sepsis played major roles in the lack of responsiveness to usual modes of therapy until the adrenal insufficiency was corrected. The patients fell into three major clinical categories of adrenal insufficiency. Chronic illness and sepsis are shown to affect steroid production and metabolism, as well as adrenal responsiveness to ACTH. Pharmacologic amounts of steroids are often needed in patients with shock, gram negative sepsis and prolonged illnesses, even if normal or elevated serum cortisols are present. Therapeutic trials of cortisol administration are shown to be confusing when not accompanied by easily performed diagnostic tests of adrenal function. It is emphasized that a pretreatment serum cortisol should be obtained whenever possible. The evaluation of adrenal function is of lifelong importance to the patient.
对八名因急性外科问题和相关肾上腺功能不全入住大学医院的患者进行了回顾，并详细介绍了其中三名患者。手术应激和持续的脓毒症在对常规治疗方式缺乏反应中起主要作用，直到肾上腺功能不全得到纠正。这些患者分为肾上腺功能不全的三大主要临床类别。慢性疾病和脓毒症被证明会影响类固醇的产生和代谢，以及肾上腺对促肾上腺皮质激素（ACTH）的反应。即使血清皮质醇正常或升高，休克、革兰氏阴性脓毒症和长期患病的患者通常也需要药理剂量的类固醇。当不伴有易于进行的肾上腺功能诊断测试时，皮质醇给药的治疗试验结果会令人困惑。强调尽可能在治疗前获取血清皮质醇。肾上腺功能评估对患者具有终身重要性。
