Kächele M, van Erp R, Schmid K, Bettac L, Wagner M, Schröppel B
Klinik für Innere Medizin I - Sektion Nephrologie, Zentrum für Innere Medizin, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland.
Klinik für Innere Medizin I - Sektion Endokrinologie, Zentrum für Innere Medizin, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland.
Internist (Berl). 2020 Jan;61(1):91-95. doi: 10.1007/s00108-019-00697-9.
This article reports the case of a 43-year-old woman who presented to the emergency room with headache and paresthesia after a fall on the head while skiing. She had clinical signs of volume depletion and blood test showed severe hyponatremia. Cerebral imaging was unremarkable. The diagnosis of cerebral salt-wasting syndrome (CSWS) was made, which is defined by the presence of extracellular volume depletion due to a tubular defect in renal sodium transport in patients with normal adrenal and thyroid function. The disease is mostly secondary to a neurological disease or head trauma. The patient rapidly improved after volume therapy and treatment with mineralocorticoids. The differentiation of CSWS from the syndrome of inappropriate antidiuretic hormone (SIADH) secretion can be challenging but the distinction is important because treatment options are very different.
本文报道了一名43岁女性的病例,该患者在滑雪时头部摔倒后出现头痛和感觉异常,被送往急诊室。她有血容量减少的临床体征,血液检查显示严重低钠血症。脑部影像学检查无异常。诊断为脑性盐耗综合征(CSWS),其定义为肾上腺和甲状腺功能正常的患者因肾小管钠转运缺陷导致细胞外液容量减少。该疾病大多继发于神经系统疾病或头部创伤。患者在进行容量治疗和使用盐皮质激素治疗后迅速好转。脑性盐耗综合征与抗利尿激素分泌不当综合征(SIADH)的鉴别可能具有挑战性,但这种区分很重要,因为治疗方案差异很大。