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Is the cosyntropin test redundant in the acutely ill patient suspected of adrenal insufficiency? A case report and literature review.对于疑似肾上腺功能不全的急性病患者，促肾上腺皮质激素试验是否多余？一例病例报告及文献综述。
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The rapid low-dose (1 microgram) cosyntropin test in the immediate postoperative period: results in elderly subjects after major abdominal surgery.术后即刻快速低剂量（1微克）促肾上腺皮质激素试验：腹部大手术后老年患者的结果
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Long-Term Opiate Therapy-Induced Secondary Adrenal Insufficiency: A Distinct Differential Diagnosis That Should Be Considered.长期阿片类药物治疗引起的继发性肾上腺皮质功能不全：一种应予以考虑的独特鉴别诊断。
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本文引用的文献

1
Pitfalls in the interpretation of the cosyntropin stimulation test for the diagnosis of adrenal insufficiency.促肾上腺皮质激素刺激试验在诊断肾上腺功能不全时的解读误区。
Curr Opin Endocrinol Diabetes Obes. 2019 Jun;26(3):139-145. doi: 10.1097/MED.0000000000000473.
2
Cosyntropin testing does not predict response to glucocorticoids in community-acquired pneumonia in a randomized controlled trial.在一项随机对照试验中，促皮质素检测不能预测社区获得性肺炎对糖皮质激素的反应。
Clin Endocrinol (Oxf). 2019 Sep;91(3):374-382. doi: 10.1111/cen.13907. Epub 2019 Jan 9.
3
Acute-Onset Panhypopituitarism Nearly Missed by Initial Cosyntropin Testing.初始促肾上腺皮质激素兴奋试验险些漏诊的急性全垂体功能减退症
Case Rep Crit Care. 2017;2017:7931438. doi: 10.1155/2017/7931438. Epub 2017 Oct 3.
4
Low-dose hydrocortisone replacement improves wellbeing and pain tolerance in chronic pain patients with opioid-induced hypocortisolemic responses. A pilot randomized, placebo-controlled trial.低剂量氢化可的松替代疗法可改善阿片类药物诱导的低皮质醇反应的慢性疼痛患者的健康状况和疼痛耐受性。一项随机、安慰剂对照的试点试验。
Psychoneuroendocrinology. 2015 Jun;56:157-67. doi: 10.1016/j.psyneuen.2015.03.015. Epub 2015 Mar 14.
5
Diagnosis and management of adrenal insufficiency.肾上腺功能不全的诊断与治疗。
Lancet Diabetes Endocrinol. 2015 Mar;3(3):216-26. doi: 10.1016/S2213-8587(14)70142-1. Epub 2014 Aug 3.
6
Is the cosyntropin test redundant in the acutely ill patient suspected of adrenal insufficiency? A case report and literature review.对于疑似肾上腺功能不全的急性病患者，促肾上腺皮质激素试验是否多余？一例病例报告及文献综述。
Tenn Med. 2010 Sep;103(8):41-3.
7
Chronic fentanyl application induces adrenocortical insufficiency.长期应用芬太尼会导致肾上腺皮质功能不全。
J Intern Med. 2005 May;257(5):478-80. doi: 10.1111/j.1365-2796.2005.01483.x.
8
Opiate receptors and anterior pituitary hormone secretion in man. Effect of naloxone infusion.人体内阿片受体与垂体前叶激素分泌。纳洛酮输注的影响。
Acta Endocrinol (Copenh). 1981 Jun;97(2):150-6. doi: 10.1530/acta.0.0970150.
9
Methadone induced hypoadrenalism.美沙酮诱发肾上腺功能减退。
Lancet. 1982 Nov 20;2(8308):1167. doi: 10.1016/s0140-6736(82)92830-6.

长期使用阿片类镇痛药引起的继发性肾上腺皮质功能减退。

Secondary adrenal insufficiency induced by long-term use of opioid analgesics.

作者信息

Ali Emad S, Peiris Alan N

机构信息

Department of Family and Community Medicine, Texas Tech University Health Science CenterLubbockTexas.

Department of Internal Medicine and Clinical Research Institute, Texas Tech University Health Science CenterLubbockTexas.

出版信息

Proc (Bayl Univ Med Cent). 2019 May 21;32(3):417-418. doi: 10.1080/08998280.2019.1600180. eCollection 2019 Jul.

DOI:10.1080/08998280.2019.1600180
PMID:31384206
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6650223/
Abstract

The effects of long-term use of opioid analgesics on the hypothalamic-pituitary-adrenal axis are not well recognized. We report a 41-year-old woman on chronic opioid therapy hospitalized for cardiovascular collapse following a right stellate ganglion nerve block. She developed severe hypotension after the procedure. Morning cortisol was low. The results from the cosyntropin test were consistent with secondary adrenal insufficiency. Her secondary adrenal insufficiency was likely due to long-term use of opioid analgesics for pain in the absence of other etiologies.

摘要

长期使用阿片类镇痛药对下丘脑-垂体-肾上腺轴的影响尚未得到充分认识。我们报告一名41岁长期接受阿片类药物治疗的女性，在接受右侧星状神经节神经阻滞后因心血管衰竭住院。术后她出现严重低血压。晨皮质醇水平较低。促肾上腺皮质激素试验结果符合继发性肾上腺功能不全。在没有其他病因的情况下，她的继发性肾上腺功能不全可能是由于长期使用阿片类镇痛药止痛所致。