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免疫功能正常的播散性隐球菌病患者因肾上腺功能不全导致的艾迪生病。病例报告。

Addison's disease due to adrenal insufficiency in an immunocompetent patient with disseminated cryptococcosis. Case report.

作者信息

Paz-Ibarra José, Concepción-Zavaleta Marcio, Tipiani Mallma Miguel, Delgado Nicolás Héctor, Herrera-Silvestre Hilder, Marcilla-Truyenque Laurie, Arzapalo-Benavides Joseph, Concepción-Urteaga Luis

机构信息

Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Perú.

Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú.

出版信息

Rev Peru Med Exp Salud Publica. 2025 Aug 25;42(2):217-222. doi: 10.17843/rpmesp.2025.422.14304.

DOI:10.17843/rpmesp.2025.422.14304
PMID:40900490
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12377890/
Abstract

Systemic mycoses, such as cryptococcosis, mainly affect the lungs and central nervous system; however, involvement of other organs, such as the adrenal glands, is rare. This has been described in some cases of primary adrenal insufficiency (PAI) of fungal origin, which are associated with high mortality. We present the case of a 65-year-old immunocompetent man who presented clinical manifestations of adrenal insufficiency. Biochemical tests confirmed PAI, and abdominal tomography revealed hyperplasia of both adrenal glands, predominantly on the left side. Left adrenalectomy was performed, and pathological examination identified granulomas and fungal structures compatible with Cryptococcus spp. The patient received hormone replacement therapy and antifungal treatment, with favorable outcome. Cryptococcal adrenalitis should be considered in the differential diagnosis of PAI, particularly in the presence of relevant epidemiological history, and timely treatment is key to improving prognosis.

摘要

全身性真菌病，如隐球菌病，主要影响肺部和中枢神经系统；然而，其他器官如肾上腺受累则较为罕见。这在一些真菌源性原发性肾上腺功能不全（PAI）病例中已有描述，这些病例死亡率很高。我们报告一例65岁免疫功能正常男性，其出现了肾上腺功能不全的临床表现。生化检查确诊为PAI，腹部断层扫描显示双侧肾上腺增生，以左侧为主。实施了左侧肾上腺切除术，病理检查发现与隐球菌属相符的肉芽肿和真菌结构。患者接受了激素替代治疗和抗真菌治疗，结果良好。在PAI的鉴别诊断中应考虑隐球菌性肾上腺炎，尤其是存在相关流行病学史时，及时治疗是改善预后的关键。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f93/12377890/6e5cc2334fb0/rpmesp-42-02-14304-g008.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f93/12377890/db0384470152/rpmesp-42-02-14304-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f93/12377890/6e5cc2334fb0/rpmesp-42-02-14304-g008.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f93/12377890/b17edb961a10/rpmesp-42-02-14304-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f93/12377890/6b1263cb18db/rpmesp-42-02-14304-g002.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f93/12377890/05557f21cf8b/rpmesp-42-02-14304-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f93/12377890/d3902e8dad87/rpmesp-42-02-14304-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f93/12377890/db0384470152/rpmesp-42-02-14304-g007.jpg
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本文引用的文献

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Cryptococcosis and Cryptococcal Meningitis: A Narrative Review and the Up-to-Date Management Approach.隐球菌病与隐球菌性脑膜炎：一篇叙述性综述及最新管理方法
Cureus. 2024 Mar 4;16(3):e55498. doi: 10.7759/cureus.55498. eCollection 2024 Mar.
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Global guideline for the diagnosis and management of cryptococcosis: an initiative of the ECMM and ISHAM in cooperation with the ASM.全球隐球菌病诊断和管理指南：欧洲癌症研究与治疗组织和国际系统性真菌感染学会与美国微生物学会合作开展的一项倡议。
Lancet Infect Dis. 2024 Aug;24(8):e495-e512. doi: 10.1016/S1473-3099(23)00731-4. Epub 2024 Feb 9.
3
Primary Adrenal Insufficiency due to Cryptococcus With Persistent Adrenal Enlargement and Insufficiency.
隐球菌所致原发性肾上腺皮质功能减退伴肾上腺持续增大及功能不全
AACE Clin Case Rep. 2023 Sep 22;9(6):189-192. doi: 10.1016/j.aace.2023.09.002. eCollection 2023 Nov-Dec.
4
Adrenal Abscesses: A Systematic Review of the Literature.肾上腺脓肿：文献系统综述
J Clin Med. 2023 Jul 11;12(14):4601. doi: 10.3390/jcm12144601.
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Tuberculosis of Adrenal Glands-A Population-based Case-control Study.肾上腺结核——一项基于人群的病例对照研究
J Endocr Soc. 2023 Apr 11;7(5):bvad047. doi: 10.1210/jendso/bvad047. eCollection 2023 Mar 6.
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