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題 名 | Treating Hyponatremia in an Empty Sella Syndrome Patient Complicated wiht Possible Myelinolysis=治療空鞍症候群合併低血鈉症併發疑似髓鞘溶解症 |
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作 者 | 李文欽; 鄭元富; 陳靖博; | 書刊名 | 長庚醫學 |
卷 期 | 25:12 2002.12[民91.12] |
頁 次 | 頁838-843 |
分類號 | 415.838 |
關鍵詞 | 補充醣皮質類固醇; 低血鈉症; 空鞍症候群; 髓鞘溶解症; Glucocorticoid substitution; Hyponatremia; Empty sella; Myelinolysis; |
語 文 | 英文(English) |
中文摘要 | 空鞍症候群用低血鈉來表現在臨床上並不常見。我們報告一位44歲女性患者,過去曾有產後大出血的病史,因低血鈉症合併意識不清而住院。一開始對病人採取的限水措施效果很有限,稍後荷爾蒙檢驗數值顯示腦下垂體功能低下,而且核磁共振攝影與腦池攝影檢查證實了空鞍症候群的診斷。雖然投予醣皮質類固醇補充,病人臨床症狀也逐漸改善,稍後病人卻產生疑似髓鞘溶解的合併症。由於及早發現並及時補充低張溶液,病人得以完全復原。我們報告這個病例,是要提醒臨床醫師對於這樣的病人,在採取限水措施的情況下,補充醣皮質類固醇有可能併發髓鞘溶解症。因此,我們建議:對於這樣的病人在補充醣皮質類固醇時,即時血清鈉的增加值仍在所謂的可接受範圍,也要更嚴密地監測血清鈉值與神經學症狀。一旦出現疑似髓鞘溶解的合併症,及早補充低張溶液是可行的做法。 |
英文摘要 | Hyponatremia as the presenting manifestation of empty sella syndrome is rare. There is little clinical experience in the management of this problem and its possible therapeutic complications We herein report on a 44-year-old woman with a past history of massive postpartum hemorrhage who was admitted because of hyponatremia and disturbed consiousness. Initial biochemical data suggested the effects of antidiuretic hormone, but fluid restriction alone offered limited benefit. Later, hormonal levels indicated hypopituitarism. Magnetic resonance imaging and cisternography led to a diagnosis of empty sella. Although glucocorticoid substitution was initated and the clinical condition initially improved, possible myelinolysis subsequently became a complication. With early recognition and immediate replacement of hypotonic fluid, the patient completely recovered. We report this case to illustrate the fact that glucocorticoid substitution and concurrent fluid restriction can probably lead to myelinolysis in empty sella syndrome patients. We suggest that the serum sodium level should be frequently monitored and that much more attention should be paid to the neurologic signs when substituting glucocorticoids in these patients, even though the increment in the serum sodium level is acceptable. Once possible myelinolysis develops, early recognition is critical, and the immediate replacement of hypotonic fluid is suggested. |
本系統中英文摘要資訊取自各篇刊載內容。