由结核病引起的艾迪生病：诊断与治疗难题
Addison's Disease Caused by Tuberculosis: Diagnostic and Therapeutic Difficulties.
作者信息
van Haren Noman Sanne, Visser Hannah, Muller Alex F, Limonard Gijs Jm
机构信息
Department of Internal Medicine, Diakonessenhuis Utrecht, Utrecht, The Netherlands.
Department of Internal Medicine, Beatrixziekenhuis, Gorinchem, The Netherlands.
出版信息
Eur J Case Rep Intern Med. 2018 Aug 28;5(8):000911. doi: 10.12890/2018_000911. eCollection 2018.
OBJECTIVES
To demonstrate difficulties in diagnosing and treating Addison's disease caused by tuberculosis.
MATERIALS AND METHODS
We present a clinical case and review of the literature.
RESULTS
A 62-year-old man presented with gastrointestinal symptoms, weight loss and enlarged adrenal glands. After 2 months of diagnostic tests, a working diagnosis of Addison's disease due to extrapulmonary tuberculosis was made. Treatment was challenging due to interaction between rifampicin and steroids.
CONCLUSION
Our case illustrates that in non-endemic countries, extrapulmonary tuberculosis still needs to be considered as a possible cause of Addison's disease.
LEARNING POINTS
In non-endemic countries, extrapulmonary tuberculosis still needs to be considered as a possible cause of Addison's disease.Treating tuberculosis and adrenal cortex insufficiency can be challenging because of the interaction between rifampicin and adrenocorticoid drugs.Adrenal function does not recover in most cases of Addison's disease caused by tuberculosis.
目的
证明诊断和治疗由结核病引起的艾迪生病存在困难。
材料与方法
我们展示了一个临床病例并进行文献回顾。
结果
一名62岁男性出现胃肠道症状、体重减轻和肾上腺肿大。经过2个月的诊断测试，作出了因肺外结核导致艾迪生病的初步诊断。由于利福平与类固醇之间的相互作用，治疗颇具挑战性。
结论
我们的病例表明，在非地方性流行国家，肺外结核仍需被视为艾迪生病的一种可能病因。
学习要点
在非地方性流行国家，肺外结核仍需被视为艾迪生病的一种可能病因。由于利福平与肾上腺皮质激素药物之间的相互作用，治疗结核病和肾上腺皮质功能不全可能具有挑战性。在大多数由结核病引起的艾迪生病病例中，肾上腺功能无法恢复。
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