Nagai Y, Ohsawa K, Hayakawa T, Abe T, Sawada T, Nakajima K, Hashizume Y, Kobayashi K
Department of Internal Medicine, Kanazawa City Hospital, Japan.
Endocr J. 1994 Apr;41(2):177-82. doi: 10.1507/endocrj.41.177.
We present a patient with Cushing's syndrome due to adrenocortical adenoma who developed acute adrenal insufficiency one month after unilateral adrenalectomy. She had received lithium carbonate for five years for manic-depressive psychosis. Drug administration was interrupted for 2 weeks postoperatively and was resumed thereafter. At the adrenal crisis, her serum free T4 and T3 levels were both high and serum TSH was subnormal. The thyrotoxicosis subsided spontaneously within 2 weeks. Serum thyroglobulin was markedly increased during the thyrotoxic state. Tests for antimicrosomal antibodies and antithyroglobulin antibodies remained negative. Examination of an open-biopsy specimen of the thyroid gland showed no evidence of thyroiditis. We considered the transient thyrotoxicosis to be due to lithium-induced thyrotoxicosis. Caution should therefore be exercised in administering lithium carbonate, especially when the patient's adrenal reserve is low, since even a mild degree of thyrotoxicosis can precipitate an acute adrenal crisis.
我们报告一例因肾上腺皮质腺瘤导致库欣综合征的患者，该患者在单侧肾上腺切除术后1个月发生急性肾上腺功能不全。她因躁狂抑郁症接受碳酸锂治疗已5年。术后停药2周，之后恢复用药。在肾上腺危象时，她的血清游离T4和T3水平均升高，血清促甲状腺激素（TSH）低于正常。甲状腺毒症在2周内自行消退。在甲状腺毒症状态期间，血清甲状腺球蛋白明显升高。抗微粒体抗体和抗甲状腺球蛋白抗体检测均为阴性。甲状腺开放活检标本检查未发现甲状腺炎证据。我们认为短暂性甲状腺毒症是由锂诱导的甲状腺毒症所致。因此，在使用碳酸锂时应谨慎，尤其是当患者肾上腺储备较低时，因为即使是轻度的甲状腺毒症也可能引发急性肾上腺危象。
