Kaufmann P, Lax S F, Radner H, Eber B, Leuger A, Smolle K H
Department of Internal Medicine, Karl-Franzens-University, Graz, Austria.
Intensive Care Med. 1995 Oct;21(10):847-9. doi: 10.1007/BF01700970.
We report an endocrine emergency of a 52-year-old woman with chronic anterior-pituitary failure of autoimmune origin who developed hypopituitary crisis with coma and severe hypotension provoked by an intercurrent bronchopneumonia. At admission to the ICU hypopituitarism had not been diagnosed and only Hashimoto's thyroiditis with thyroid replacement therapy could be obtained from the patient's history. Although the patient presented with somatic signs suggestive of hypopituitarism, other causes of coma and hypotension had first to be excluded. In the absence of specific treatment the patient died 18 h later with refractory cardiac arrest. Diagnosis of acute decompensated chronic hypophyseal failure must be considered if hypothermia, refractory hypotension and signs of infection without fever are associated with a short stature and the loss of axillary and public hair. Waiting for laboratory confirmation of the diagnosis must not delay immediate life-saving specific glucocorticoid treatment.
我们报告了一例52岁女性的内分泌急症，该患者患有自身免疫性起源的慢性垂体前叶功能减退，因并发支气管肺炎引发垂体功能减退危象，出现昏迷和严重低血压。入住重症监护病房（ICU）时，垂体功能减退尚未被诊断出来，从患者病史中仅得知有桥本甲状腺炎且正在接受甲状腺替代治疗。尽管患者出现了提示垂体功能减退的体征，但首先必须排除昏迷和低血压的其他原因。由于缺乏特异性治疗，患者在18小时后死于难治性心脏骤停。如果体温过低、难治性低血压以及无发热的感染体征与身材矮小、腋毛和阴毛脱落相关，必须考虑急性失代偿性慢性垂体功能衰竭的诊断。等待实验室确诊一定不能延误立即挽救生命的特异性糖皮质激素治疗。
