Altunok Murat, Kızıltunç Hüsnü Serdar, Çankaya Erdem, Sevinç Can, Uyanık Abdullah
Department of Nephrology, Faculty of Medicine, Atatürk University, Erzurum, Turkey.
Department of Internal Medicine, Eleşkirt State Hospital, Ağrı, Turkey.
Semin Dial. 2024 Nov-Oct;37(6):456-460. doi: 10.1111/sdi.13225. Epub 2024 Aug 22.
Hypotension is a common complication during hemodialysis that develops due to high ultrafiltration rate and sometimes requires intravenous fluid replacement. Intradialytic hypotension may reduce the effectiveness of dialysis and contributes to hemodialysis-related morbidity and mortality. Adrenal insufficiency is one of the causes of hypotension in the community. Our case was diagnosed with end-stage renal failure and was undergoing routine hemodialysis with a central venous catheter 3 days a week. Upon the patient's hypotension attacks during the dialysis sessions and hypoglycemia attacks in the follow-ups, the morning cortisol was 6.2 μg/dL. Adrenocorticotropic hormone was 39 pg/mL, and testosterone was 0.0442 ng/mL. Adrenocorticotropic hormone stimulation test was performed on the patient with 250 mcg tetracosactide. The patient did not show adequate cortisol response, was detected to have partial empty sella on pituitary magnetic resonance imaging, and was diagnosed with secondary adrenal insufficiency, and then the hemodialysis hypotension improved with prednisolone treatment. We present a case of adrenal insufficiency, which is a rare cause of hypotension in patients on routine hemodialysis.
低血压是血液透析期间的常见并发症，由高超滤率引起，有时需要静脉补液。透析期间的低血压可能会降低透析效果，并导致与血液透析相关的发病率和死亡率。肾上腺功能不全是社区中低血压的原因之一。我们的病例被诊断为终末期肾衰竭，每周通过中心静脉导管进行3次常规血液透析。在透析期间患者出现低血压发作以及随访期间出现低血糖发作时，早晨皮质醇为6.2μg/dL。促肾上腺皮质激素为39pg/mL，睾酮为0.0442ng/mL。用250μg替可克肽对患者进行促肾上腺皮质激素刺激试验。患者未表现出足够的皮质醇反应，垂体磁共振成像检测到有空蝶鞍，诊断为继发性肾上腺功能不全，随后泼尼松龙治疗使血液透析低血压得到改善。我们报告一例肾上腺功能不全病例，这是常规血液透析患者低血压的罕见原因。
