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題 名 | 非何杰金氏淋巴瘤併雙側腎上腺侵犯引起之腎上腺功能低下--一病例報告=Adrenal Insufficiency Caused by Non-Hodgkin's Lymphoma with Bilateral Adrenal Involvement--A Case Report |
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作 者 | 郭聰永; 王朝弘; 楊超然; 林炯森; 詹錕鋙; 曾嶔元; | 書刊名 | 內科學誌 |
卷 期 | 12:2 2001.04[民90.04] |
頁 次 | 頁94-98 |
分類號 | 415.6 |
關鍵詞 | 原發性腎上腺功能低下; 愛迪森氏症; 非何杰金氏淋巴瘤; 腎上腺腫瘤; Primary adrenal insufficiency; Addison's disease; Non-Hodgkin's lymphoma; Adrenal tumor; |
語 文 | 中文(Chinese) |
中文摘要 | 一位54歲男性,因全身無力、疲倦、體重減輕、食慾不佳與腹痛約10天而至急診 室求治。身體檢查發現病人意識清楚,全身皮膚黝黑,腹部柔軟但有瀰漫性壓痛。生命徵象 顯示病人有發燒至 39.5 ℃, 低血壓 (血壓 80/44 mmHg) 與心搏過速 (120 次 / 分 ) 情 形。腹部超音波與電腦斷層掃描顯示雙側腎上腺有很大腫塊。因懷疑有急性腎上腺功能低下 , 住院後立即給予靜脈輸注 hydrocortisone。 隔日早晨檢驗顯示血中 cortisol 值偏低 (6.5 μ g/dL) 與 ACTH 值升高 (352 pg/mL)。因持續腹痛,故剖腹診察,發現有雙側腎上 腺腫瘤併多處腸繫膜淋巴結腫大與小腸沾黏。病理報告證實雙側腎上腺腫瘤與腸繫膜淋巴結 皆為瀰漫性大 B 細胞淋巴瘤侵犯。 病人在接受化學治療前因敗血症與急症腎衰竭而死亡。 原發性腎上腺功能低下常因自體免疫、感染、腫瘤與藥物引起。非何杰金氏淋巴瘤侵犯到腎 上腺約佔 4-25 %,但以腎上腺功能低下表現則很少見。治療選擇為化學治療加上適量補充 類固醇, 不過病人的預後通常不佳,當病人出現雙側腎上腺超過 6 公分的腫塊併功能低下 時,惡性腫瘤,包括淋巴瘤,必須列入鑑別診斷之中。 |
英文摘要 | A 54 year-old man was brought to the emergency room because of general weakness, fatigue, body weight loss, anorexia and abdominal pain for about 10 days. Except for cutaneous hyperpigmentation and diffuse abdominal tenderness, there were no other abnormalities found on physical examination. Fever (BT 39.5 ℃ ), hypotension (BP 80/44 mmHg) and tachycardia (120/min) were noted at ER. Bilateral large adrenal masses were found on abdominal ultrasound and computed tomographic scan. Because acute drenal insufficiency was highly suspected, replacement therapy was started with intravenous hydrocortisone soon aftetr admission. Clinical suspicion of primary adrenal insufficiency was confirmed by a high morning serum ACTH level (352 pg/mL) and low morning serum cortisol level (6.5 μ g/dL). Exploratory laparotomy was performed due to persistent abdominal pain. Bilateral adrenal tumors, multiple enlarged mesenteric lymph node and small bowel adhesion were noted. Pathology of bilateral adrenal glands and mesenteric lymph node revealed diffuse. large B cell lymphoma. This patient expired from sepsis and acute renal failure before chemotherapy could be started. The causes of primary adrenal insufficiency include autoimmune adrenalitis, infection, metastases and drugs. The incidence of adrenal involvement by non-Hodgkin's lymphoma (NHL) is 4-25% according to various studies. NHL presenting with primary adrenal insufficiency due to bilateral adrenal involvement is very rare. Chemotherapy with steroid replacement is the treatment of choice. The prognosis is very poor, usually due to delayed diagnosis. Malignancy, including NHL, should be considered as a potential etiology in a patient presenting with bilateral adrenal masses more than 6 cm in diameter and symptomas and signs of adrenal insufficiency. |
本系統中英文摘要資訊取自各篇刊載內容。