Webster J B, Bell K R
Department of Rehabilitation Medicine, University of Washington, Seattle 98195, USA.
Arch Phys Med Rehabil. 1997 Mar;78(3):314-8. doi: 10.1016/s0003-9993(97)90040-x.
Primary adrenal insufficiency (PAI) is a relatively rare but serious condition that can lead to signs and symptoms ranging from mild generalized weakness and fatigue to fulminant shock and death. We present the case of a previously healthy 31-year-old man who developed PAI while undergoing rehabilitation after a severe traumatic brain injury (TBI). The patient suffered a TBI with comminuted skull fractures, bifrontal confusions, and bilateral epidural hematomas in a jet-ski accident. Acute hospitalization was prolonged by several medical complications, and the patient was admitted for subacute rehabilitation 1 month after his injury with cognitive deficits, persistent agitation, confusion, generalized weakness, and poor endurance for therapy. His weakness, fatigue, and orthostasis did not improve with attempts at gradual remobilization. The patient also had persistent anorexia, nausea, and hyponatremia despite various treatment regimens. Endocrinology workup showed normal anterior pituitary function but an abnormal response to adrenocorticotropic hormone (ACTH) stimulation, leading to the diagnosis of PAI. The patient was treated with prednisone and fludrocortisone, which resulted in improvement in clinical symptoms followed by rapid gains in all functional areas. No previous descriptions of PAI following head injury were found in the medical literature. It is important for physiatrists to be aware of this entity because symptoms of adrenal insufficiency can be similar to those commonly seen with TBI alone. PAI may also be confused with other endocrine disorders more frequently seen after TBI such as the syndrome of inappropriate antidiuretic hormone secretion. Recognition and appropriate management of adrenal insufficiency can lead to significant clinical and functional gains.
原发性肾上腺功能不全（PAI）是一种相对罕见但严重的疾病，可导致从轻度全身无力和疲劳到暴发性休克和死亡等一系列体征和症状。我们报告一例既往健康的31岁男性病例，该患者在严重创伤性脑损伤（TBI）后接受康复治疗期间发生了PAI。患者在一次喷气式滑水事故中遭受了TBI，伴有粉碎性颅骨骨折、双额叶意识模糊和双侧硬膜外血肿。由于多种医疗并发症，急性住院时间延长，患者在受伤1个月后因认知缺陷、持续躁动、意识模糊、全身无力和治疗耐力差而入院接受亚急性康复治疗。尽管尝试逐步恢复活动，但他的虚弱、疲劳和直立性低血压并未改善。尽管采用了各种治疗方案，患者仍持续存在厌食、恶心和低钠血症。内分泌检查显示垂体前叶功能正常，但对促肾上腺皮质激素（ACTH）刺激反应异常，从而导致PAI的诊断。患者接受了泼尼松和氟氢可的松治疗，临床症状得到改善，随后所有功能领域都迅速恢复。医学文献中未发现此前关于头部损伤后PAI的描述。对于物理治疗师来说，了解这种疾病很重要，因为肾上腺功能不全的症状可能与单纯TBI常见的症状相似。PAI也可能与TBI后更常见的其他内分泌疾病混淆，如抗利尿激素分泌不当综合征。认识并适当管理肾上腺功能不全可带来显著的临床和功能改善。
