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題 名 | Genitourinary Tuberculosis Complicated with Adrenal Involvement and Primary Adrenocortical Insufficiency: A Case Report=生殖泌尿道結核合併腎上腺侵犯造成原發性腎上腺皮質功能不全:一病例報告 |
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作 者 | 林時逸; 張嘉麟; 葉振聲; 林宏達; 翁錦興; | 書刊名 | 中華醫學雜誌 |
卷 期 | 61:3 民87.03 |
頁 次 | 頁170-174 |
分類號 | 415.825 |
關鍵詞 | 生殖泌尿道結核; 原發性腎上腺皮質功能不全; Genitourinary tuberculosis; Primary adrenocortical insufficiency; |
語 文 | 英文(English) |
中文摘要 | 生殖泌尿道結核合併腎上腺侵犯,在臨床上極為罕見。我們報告一位六十七歲男性病例。病患因最近2.3個月來,有皮膚顏色逐漸加深,及兩側睪丸腫塊,而至本院求診。血漿皮醇濃度偏低,腎上皮促素濃度膈高。腎上皮促素刺激試驗顯示:血漿皮醇對腎上皮促素並無反應。因此診斷為:原發性腎上腺皮質功能不足。腹部電腦斷層發現,右側腎上腺變大,而左側腎上腺有點狀鈣化現象,高度疑為結核性腎上腺病。攝護腺組織穿刺檢查,顯示有慢性肉芽組織發炎及Langerhan巨細胞,但無結核菌之發現。病人接受醣質固醇及礦物質固醇補充,並接受抗結核藥治療。6個月之後,睪丸腫塊及皮膚變黑現象逐漸消失,但腎上腺皮質功能卻無明顯之進步。一年半後之腹部電腦斷層追蹤,顯示右側腎上腺腫塊有變小現象。 |
英文摘要 | Genitourinary tuberculosis (TB) rarely involves the adrenal gland. A 67-year-old man presented with progressively hyperpigmented skin and an enlarged mass over both testes. Early morning plasma cortisol concentration was low and adrenocorticotropic hormone (ACTH) concentration was high. A rapid ACTH stimulation test revealed the absence of plasma cortisol response and confirmed a diagnosis of primary adrenocortical insufficiency. An abdomen computed tomography (CT) scan disclosed enlargement of the right adrenal gland and punctuate calcification over the left one. This is compatible with tuberculous adrenalitis. Currettage biopsy of the prostate demonstrated chronic granulomatous inflammation with Langerhan's giant cells, but without TB bacilli. Anti-TB treatment, in addition to glucocorticoid and mineralocorticoid replacement, was administered. The testicular mass decreased progressively though the results of a subsequent ACTH stimulation test, six months later, disclosed no significant change. A follow-up CT scan, one and a half years later, showed a decrease in the size of the right adrenal mass. |
本系統中英文摘要資訊取自各篇刊載內容。