继发于创伤性脑损伤的垂体前叶功能减退症引起的肌水肿昏迷。

IF 0.9 Q4 ENDOCRINOLOGY & METABOLISM
Case Reports in Endocrinology Pub Date : 2024-10-16 eCollection Date: 2024-01-01 DOI:10.1155/2024/3588840
Diego Rivas-Otero, Tomás González-Vidal, Pedro Pujante Alarcón, Elías Delgado Álvarez, Edelmiro Menéndez Torre
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引用次数: 0

摘要

背景/目的:肌水肿性昏迷通常表现为意识水平下降和体温过低,这通常是由甲状腺病变引起的。在中枢性病因中,正常的促甲状腺激素(TSH)水平可能会延误诊断。本报告旨在描述一名有头部外伤史的患者因泛垂体功能减退症而出现的肌水肿性昏迷。病例报告:入院患者是一名 52 岁的男性,表现为精神和身体迟钝、嗜睡和虚弱。他还伴有低血压、低血糖和低血氧饱和度。初步评估显示,他有严重的心包积液和双侧胸腔积液,血浆促甲状腺激素(TSH)为 2.42 mU/L(正常范围为 0.25-5.00 mU/L),血浆促肾上腺皮质激素(ACTH)为 7.1 pg/mL(正常范围为 5.2-40.3 pg/mL)。后来,他的病情恶化,出现贫血和昏迷。静脉注射皮质类固醇后,他的病情出现好转迹象。随后进行的血液检测显示,游离甲状腺素(FT4)水平为 0.14 纳克/分升(正常范围为 0.93-1.70 纳克/分升)。头颅磁共振扫描显示有创伤后病变。患者家属后来承认患者在家中头部受伤。患者开始接受静脉注射左甲状腺素治疗,结果病情有所好转,随后在完全清醒的状态下出院。结论有头部外伤和激素缺乏症状的患者应怀疑垂体功能减退症。晚期临床表现,如肌萎缩性昏迷,也可能发生。垂体激素水平可能在正常范围内,因此应评估靶腺激素以作出诊断。如果怀疑是中枢性甲状腺功能减退症,只要求检测促甲状腺激素水平可能会导致漏诊。因此,在怀疑中枢性甲减的情况下,应同时测量 TSH 和 FT4 水平。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Myxedema Coma as a Presentation of Panhypopituitarism Secondary to Traumatic Brain Injury.

Background/Objective: Myxedema coma typically presents with decreased level of consciousness and hypothermia, often due to thyroid pathology. In central causes, normal thyroid-stimulating hormone (TSH) levels may delay diagnosis. The purpose of this report is to describe a patient with a history of head trauma who presented with myxedema coma as a manifestation of panhypopituitarism. Case Report: The admitted patient was a 52-year-old man who presented with mental and physical slowness, drowsiness, and weakness. He also had hypotension, hypoglycemia, and low oxygen saturation. Initial evaluation revealed severe pericardial and bilateral pleural effusions, plasma TSH of 2.42 mU/L (normal range 0.25-5.00 mU/L), and plasma adrenocorticotropic hormone (ACTH) of 7.1 pg/mL (normal range 5.2-40.3 pg/mL). Later, his condition deteriorated with anasarca and coma. Signs of improvement were noted after intravenous corticosteroid administration. A subsequent blood test was conducted, which showed a free thyroxine (FT4) level of 0.14 ng/dL (normal range 0.93-1.70 ng/dL). A cranial magnetic resonance scan revealed posttraumatic lesions. The patient's family later admitted head injuries at home. Treatment with intravenous levothyroxine was initiated, resulting in improvement and subsequent discharge in perfect alertness. Conclusion: Hypopituitarism should be suspected in patients with head trauma and symptoms of hormone deficiency. Advanced clinical forms, such as myxedema coma, may also occur. Pituitary hormone levels might be in the normal range, so target gland hormones should be assessed to reach a diagnosis. In the case of suspected central hypothyroidism, requesting only TSH levels may result in a missed diagnosis. For this reason, both TSH and FT4 levels should be measured when central hypothyroidism is suspected.

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来源期刊
Case Reports in Endocrinology
Case Reports in Endocrinology ENDOCRINOLOGY & METABOLISM-
CiteScore
2.10
自引率
0.00%
发文量
45
审稿时长
13 weeks
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