Department of Critical Care, University Medical Center Groningen and University of Groningen, Groningen, the Netherlands.
Crit Care Med. 2010 Jul;38(7):1598-601. doi: 10.1097/CCM.0b013e3181e47b7a.
To illustrate the importance of recognizing symptoms of severe hypercortisolism in the intensive care unit and key emergency measures to reduce this extreme hypercortisolism.
Case report.
Intensive care unit in a university hospital.
A 55-yr-old woman was admitted to the intensive care unit with multiorgan failure after perforation of the sigmoid. Recent-onset hypertension, spontaneous hypokalemia, and diabetes mellitus suggested severe Cushing's syndrome as the underlying disease. Markedly increased serum cortisol (5900 nmol/L) and adrenocorticotropic hormone (302 ng/L) levels were found, highly suggestive for ectopic adrenocorticotropic hormone secretion. Imaging studies failed to unequivocally establish a solitary source of ectopic adrenocorticotropic hormone secretion. The deteriorating condition of the patient urged rapid intervention.
Etomidate was infused continuously to reduce endogenous adrenal cortisol secretion. Subsequently, a rescue bilateral adrenalectomy was undertaken.
Etomidate effectively reduced the cortisol level. Serial blood samples were obtained during the bilateral adrenalectomy. Plasma adrenocorticotropic hormone markedly decreased immediately after resection of the right adrenal gland. Histopathological examination revealed a tumor of the right adrenal gland identified as a pheochromocytoma and hyperplasia of the left adrenal gland, but no signs of malignancy. The patient recovered slowly.
This case illustrates that severe hypercortisolism is a medical emergency and that specific and prompt combined medical and surgical intervention can be life-saving.
阐明在重症监护病房识别严重皮质醇增多症症状的重要性，以及降低这种极度皮质醇增多症的关键急救措施。
病例报告。
一所大学医院的重症监护病房。
一名 55 岁女性因乙状结肠穿孔导致多器官衰竭后被收入重症监护病房。近期出现的高血压、自发性低钾血症和糖尿病提示潜在的严重库欣综合征。明显升高的血清皮质醇（5900nmol/L）和促肾上腺皮质激素（302ng/L）水平高度提示异位促肾上腺皮质激素分泌。影像学检查未能明确确定单一的异位促肾上腺皮质激素分泌源。患者病情恶化促使需要迅速干预。
连续输注依托咪酯以减少内源性肾上腺皮质醇分泌。随后进行双侧肾上腺切除术抢救。
依托咪酯有效地降低了皮质醇水平。在双侧肾上腺切除术中连续采集血样。切除右侧肾上腺后，血浆促肾上腺皮质激素立即明显下降。组织病理学检查显示右侧肾上腺肿瘤为嗜铬细胞瘤，左侧肾上腺增生，但无恶性迹象。患者恢复缓慢。
本病例说明严重皮质醇增多症是一种医疗急症，具体和及时的联合医疗和手术干预可以挽救生命。
