A Rare Cause of Hypotension in Routine Hemodialysis: Secondary Adrenal Insufficiency.

IF 1.4 4区 医学 Q3 UROLOGY & NEPHROLOGY
Seminars in Dialysis Pub Date : 2024-11-01 Epub Date: 2024-08-22 DOI:10.1111/sdi.13225
Murat Altunok, Hüsnü Serdar Kızıltunç, Erdem Çankaya, Can Sevinç, Abdullah Uyanık
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引用次数: 0

Abstract

Hypotension is a common complication during hemodialysis that develops due to high ultrafiltration rate and sometimes requires intravenous fluid replacement. Intradialytic hypotension may reduce the effectiveness of dialysis and contributes to hemodialysis-related morbidity and mortality. Adrenal insufficiency is one of the causes of hypotension in the community. Our case was diagnosed with end-stage renal failure and was undergoing routine hemodialysis with a central venous catheter 3 days a week. Upon the patient's hypotension attacks during the dialysis sessions and hypoglycemia attacks in the follow-ups, the morning cortisol was 6.2 μg/dL. Adrenocorticotropic hormone was 39 pg/mL, and testosterone was 0.0442 ng/mL. Adrenocorticotropic hormone stimulation test was performed on the patient with 250 mcg tetracosactide. The patient did not show adequate cortisol response, was detected to have partial empty sella on pituitary magnetic resonance imaging, and was diagnosed with secondary adrenal insufficiency, and then the hemodialysis hypotension improved with prednisolone treatment. We present a case of adrenal insufficiency, which is a rare cause of hypotension in patients on routine hemodialysis.

常规血液透析中低血压的罕见病因:继发性肾上腺功能不全。
低血压是血液透析过程中常见的并发症,由于超滤率高而产生,有时需要静脉补充液体。椎管内低血压可能会降低透析效果,并导致与血液透析相关的发病率和死亡率。肾上腺功能不全是导致社区低血压的原因之一。我们的病例被诊断为终末期肾衰竭,每周 3 天使用中心静脉导管进行常规血液透析。患者在透析期间发作低血压,在随访中发作低血糖,早晨皮质醇为 6.2 μg/dL。肾上腺皮质激素为 39 pg/mL,睾酮为 0.0442 ng/mL。用 250 微克四碳嘧啶对患者进行了促肾上腺皮质激素刺激试验。患者未表现出足够的皮质醇反应,垂体磁共振成像检测到部分蝶鞍空洞,被诊断为继发性肾上腺功能不全,后经泼尼松龙治疗,血液透析低血压有所改善。我们介绍了一例肾上腺功能不全病例,这是常规血液透析患者出现低血压的罕见原因。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Seminars in Dialysis
Seminars in Dialysis 医学-泌尿学与肾脏学
CiteScore
3.00
自引率
6.20%
发文量
91
审稿时长
4-8 weeks
期刊介绍: Seminars in Dialysis is a bimonthly publication focusing exclusively on cutting-edge clinical aspects of dialysis therapy. Besides publishing papers by the most respected names in the field of dialysis, the Journal has unique useful features, all designed to keep you current: -Fellows Forum -Dialysis rounds -Editorials -Opinions -Briefly noted -Summary and Comment -Guest Edited Issues -Special Articles Virtually everything you read in Seminars in Dialysis is written or solicited by the editors after choosing the most effective of nine different editorial styles and formats. They know that facts, speculations, ''how-to-do-it'' information, opinions, and news reports all play important roles in your education and the patient care you provide. Alternate issues of the journal are guest edited and focus on a single clinical topic in dialysis.
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