一名患有多发性血栓栓塞的产后妇女双侧肾上腺出血:病例报告。

IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL
Anna Yi Nan Jiang, Joshua Haron Abasszade, Timothy Abrahams, Kirollos Nan, Michael Sze Yuan Low, Sara Laura Barnes, Ann Nee Lim, Jimmy Zhen Long Shen
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引用次数: 0

摘要

背景:双侧肾上腺出血是原发性肾上腺功能不全的一种罕见病因,但往往是一种致命病因,如果不能及时发现和妥善处理,可导致肾上腺危象:本病例为一名 27 岁的白种女性,因胸膜炎性胸部和侧腹疼痛、气短和恶心于产后 17 天入院。计算机断层扫描成像证实了多处血栓栓塞,包括肺栓塞,并发现双侧肾上腺肿大。她因感染和肺栓塞接受了治疗;然而,尽管接受了适当的治疗,她仍抱怨持续头痛、恶心和呕吐。放射科再次复查后发现,计算机断层扫描成像结果与双侧肾上腺出血一致。随后通过下丘脑-垂体-肾上腺轴检查和促肾上腺皮质激素(Synacthen)刺激试验进行了内分泌评估,结果证实为原发性肾上腺功能不全。她需要紧急静脉注射氢化可的松,随后在口服肾上腺替代疗法和抗凝治疗后出院:结论:肾上腺功能不全的诊断和治疗延误可导致灾难性后果。本病例凸显了诊断双侧肾上腺出血和由此导致的肾上腺功能不全所面临的挑战,因为患者可能不会出现典型的危险因素、体征、症状和电解质紊乱。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Bilateral adrenal hemorrhage in a postpartum woman with multiple thromboemboli: A case report.

Background: Bilateral adrenal hemorrhage is a rare but often a fatal cause of primary adrenal insufficiency that can result in adrenal crisis if not identified and managed appropriately.

Case presentation: We present a case of a 27-year-old Caucasian female who was admitted to the hospital 17 days postpartum with pleuritic chest and flank pain, shortness of breath and nausea. Computed tomography imaging confirmed multiple thromboemboli including pulmonary emboli and noted bilateral bulky adrenal glands. She was managed for infection and pulmonary emboli; however, she complained of persistent headaches, nausea, and vomiting despite appropriate management. Radiology re-review found the computed tomography imaging was consistent with bilateral adrenal hemorrhage in hindsight. Subsequent endocrine evaluation with hypothalamic-pituitary-adrenal axis interrogation and adrenocorticotropic hormone (Synacthen) stimulation testing confirmed resultant primary adrenal insufficiency. She required urgent intravenous hydrocortisone and was subsequently discharged on oral adrenal replacement therapy and anticoagulation.

Conclusions: Delay in identification and treatment of adrenal insufficiency can lead to catastrophic outcomes. This case highlights the challenge of diagnosing bilateral adrenal hemorrhage and resultant adrenal insufficiency as patients may not present with the classic risk factors, signs, symptoms, and electrolyte derangements.

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来源期刊
Journal of Medical Case Reports
Journal of Medical Case Reports Medicine-Medicine (all)
CiteScore
1.50
自引率
0.00%
发文量
436
期刊介绍: JMCR is an open access, peer-reviewed online journal that will consider any original case report that expands the field of general medical knowledge. Reports should show one of the following: 1. Unreported or unusual side effects or adverse interactions involving medications 2. Unexpected or unusual presentations of a disease 3. New associations or variations in disease processes 4. Presentations, diagnoses and/or management of new and emerging diseases 5. An unexpected association between diseases or symptoms 6. An unexpected event in the course of observing or treating a patient 7. Findings that shed new light on the possible pathogenesis of a disease or an adverse effect
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