认识肢端肥大症的多种临床表现:系列病例的启示

Salam MU, Jabeen R, Ahmad MM, Islam MN, Haque MR, Sharker S, Chowdhury NB, Alam S, Rahman S
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摘要

目的:肢端肥大症是一种因生长激素过多而导致的内分泌疾病,其表现发展缓慢,临床表现多种多样。患者有可能出现一些常见的临床问题,而潜在的内分泌疾病却被忽视,从而延误诊断。本病例系列将讨论四个肢端肥大症病例的表现、临床特征和检查,以提高医生的临床技能,从而及早做出诊断,及早开始治疗:这是一项观察性研究,研究对象为孟加拉国锡尔赫特女子医学院住院或门诊的四例肢端肥大症患者。研究人员通过详细的临床特征和检查结果对这些病例进行了分析。脑部核磁共振成像是诊断的主要工具。对所有患者的血清生长激素、IGF-1、促甲状腺激素、促肾上腺皮质激素和催乳素水平进行了评估。还选择性地进行了其他垂体前叶激素检测。对所有患者进行了眼部检查:虽然病例系列作为医学证据的价值低于系统综述和随机临床试验,但它有助于制定未来的研究方案。这组病例强调,医生敏锐的临床眼光有助于肢端肥大症的早期诊断,因此,根据临床怀疑及早进行脑部核磁共振成像检查可确保早期治疗并预防心血管并发症。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Recognizing the Diverse Clinical Presentations of Acromegaly: Insight from a Case Series
Purpose: Acromegaly is an endocrine disease due to growth hormone excess with slowly developing manifestations and diverse clinical presentations. There are chances that patients may present with common clinical problems and the underlying endocrine condition is overlooked and diagnosis is delayed. This case series will discuss the presentation, clinical features and investigations of four acromegaly cases to increase the clinical skills of physicians so that an early diagnosis is made and treatment is initiated early. Methods: This is an observational study, where a series of four acromegaly cases, who presented to medicine inpatients or outpatients of Sylhet Women’s Medical College, Bangladesh. They were analyzed through detailed clinical features and, investigation findings. MRI brain was used as the main tool for diagnosis. Serum levels of growth hormone, IGF-1, TSH, ACTH, and prolactin were assessed in all. Other anterior pituitary hormone assays were selectively done. Ocular examinations were performed on all patients. Conclusion: Though a case series has lower value as medical evidence than systematic reviews and randomized clinical trials, it can help in generating future protocols of studies. This series emphasizes that a keen clinical eye of the physician can help in early diagnosis of acromegaly and thus an early MRI of brain based on clinical suspicion can ensure early treatment and prevent cardiovascular complications.
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