Tanaka Masami, Suganuma Kazuki, Funase Yoshiko, Minami Satoshi, Shirotori Katsuko, Oguchi Tomomasa, Kamijo Tsuyoshi, Koyama Toru, Aizawa Toru
Diabetes Center.
Department of Nephrology.
NDT Plus. 2011 Feb;4(1):36-8. doi: 10.1093/ndtplus/sfq188. Epub 2010 Nov 12.
A 62-year-old man, receiving chronic haemodialysis and suffering from alcoholic liver cirrhosis and chronic pancreatitis, presented with hypoglycaemic coma. Plasma cortisol was undetectable (< 5.5 nmol/L) with suppressed adrenocorticotropic hormone (ACTH), which established a diagnosis of adrenal failure due to ACTH deficiency. Twenty-five milligrams of oral hydrocortisone eradicated hypoglycaemia. Presentation of adrenal failure in this patient was atypical because he was hypertensive, serum electrolytes including sodium were normal and anaemia was unremarkable, which were all due to end-stage renal disease and its treatment with haemodialysis. As far as we are aware, this is the first case report of hypoglycaemic coma due to adrenal failure in a chronic haemodialysis patient.
一名62岁男性，接受慢性血液透析治疗，患有酒精性肝硬化和慢性胰腺炎，出现低血糖昏迷。血浆皮质醇检测不到（<5.5 nmol/L），促肾上腺皮质激素（ACTH）受到抑制，从而确诊为ACTH缺乏导致的肾上腺功能不全。口服25毫克氢化可的松后低血糖症状消失。该患者肾上腺功能不全的表现不典型，因为他患有高血压，包括钠在内的血清电解质正常，贫血也不明显，这些均归因于终末期肾病及其血液透析治疗。据我们所知，这是首例关于慢性血液透析患者因肾上腺功能不全导致低血糖昏迷的病例报告。
