Nishikawa M, Toyoda N, Miyaji M, Higuchi M, Yonemoto T, Ogawa Y, Sakaguchi N, Tokoro T, Iwasaka T, Inada M
Second Department of Internal Medicine, Kansai Medical University, Osaka, Moriguchi.
Intern Med. 1998 Apr;37(4):398-402. doi: 10.2169/internalmedicine.37.398.
We report a 62-year-old male patient who had variant angina and isolated adrenocorticotropic hormone (ACTH) deficiency. His serum sodium concentration was low and vasopressin was inappropriately high for the low plasma osmolality. Serum free thyroxine (FT4) was low and thyroid stimulating hormone (TSH) was high with positive anti-thyroperoxidase antibodies, compatible with Hashimoto's thyroiditis. Treatment with Amrodipine and hydrocortisone relieved chest symptoms and hyponatremia, and hypothyroidism was also normalized. It is suggested that coronary artery spasm may be related to cortisol deficiency and/or inappropriately high vasopressin secretion and that hypothyroidism was ameliorated because the reduced responsiveness to TSH returned to normal due to hydrocortisone supplement.
我们报告了一名62岁男性患者，他患有变异型心绞痛和孤立性促肾上腺皮质激素（ACTH）缺乏症。他的血清钠浓度较低，而对于低血浆渗透压，血管加压素水平却不适当升高。血清游离甲状腺素（FT4）水平低，促甲状腺激素（TSH）水平高，抗甲状腺过氧化物酶抗体呈阳性，符合桥本甲状腺炎。使用氨氯地平和氢化可的松治疗缓解了胸部症状和低钠血症，甲状腺功能减退也恢复正常。提示冠状动脉痉挛可能与皮质醇缺乏和/或血管加压素分泌不适当升高有关，并且甲状腺功能减退得到改善是因为补充氢化可的松后对TSH降低的反应性恢复正常。
