目的:探讨慢性酒精中毒假性皮质醇增多症的临床特征、辅助检查、诊治方法和预后。方法:对1例慢性酒精中毒导致假性皮质醇增多及其他并发症的病例进行临床特点、实验室检查、影像学特点研究。结合文献分析本病的临床表现、实验室指标及治疗转归。结果:慢性酒精中毒很少导致皮质醇增多,常导致电解质紊乱、周围神经损害、肝功能损害等。结论:慢性酒精中毒患者需完善皮质醇检查及其他常见并发症的筛查,及时戒酒,补充大量维生素,改善预后。 Objective: To investigate the clinical features, auxiliary examination, diagnosis and treatment, and prognosis of pseudocortisol in chronic alcoholism. Methods: A patient with pseudocortisol and other complications caused by chronic alcoholism was selected to investigate the clinical characteristics, laboratory examination and imaging characteristics. The clinical manifestations, laboratory parameters and treatment outcome were analyzed. Results: Chronic alcoholism rarely leads to the increase of cortisol, and often leads to electrolyte disorder, peripheral nerve damage, liver function damage and so on. Conclusion: The patients with chronic alcoholism need to improve the screening of cortisol examination and other common complications, quit drinking in time, supplement a lot of vitamins, and improve the prognosis.
目的:探讨慢性酒精中毒假性皮质醇增多症的临床特征、辅助检查、诊治方法和预后。方法:对1例慢性酒精中毒导致假性皮质醇增多及其他并发症的病例进行临床特点、实验室检查、影像学特点研究。结合文献分析本病的临床表现、实验室指标及治疗转归。结果:慢性酒精中毒很少导致皮质醇增多,常导致电解质紊乱、周围神经损害、肝功能损害等。结论:慢性酒精中毒患者需完善皮质醇检查及其他常见并发症的筛查,及时戒酒,补充大量维生素,改善预后。
慢性酒精中毒,假性皮质醇增多
Rong Luo, Peirong Xiao
Department of Neurology, The Affiliated Yancheng Hospital of Southeast University Medical College, Yancheng Jiangsu
Received: Feb. 25th, 2021; accepted: Mar. 12th, 2021; published: Mar. 31st, 2021
Objective: To investigate the clinical features, auxiliary examination, diagnosis and treatment, and prognosis of pseudocortisol in chronic alcoholism. Methods: A patient with pseudocortisol and other complications caused by chronic alcoholism was selected to investigate the clinical characteristics, laboratory examination and imaging characteristics. The clinical manifestations, laboratory parameters and treatment outcome were analyzed. Results: Chronic alcoholism rarely leads to the increase of cortisol, and often leads to electrolyte disorder, peripheral nerve damage, liver function damage and so on. Conclusion: The patients with chronic alcoholism need to improve the screening of cortisol examination and other common complications, quit drinking in time, supplement a lot of vitamins, and improve the prognosis.
Keywords:Chronic Alcoholism, Pseudocortisol
Copyright © 2021 by author(s) and Hans Publishers Inc.
This work is licensed under the Creative Commons Attribution International License (CC BY 4.0).
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假性皮质醇增多症是慢性酒精中毒极为罕见的并发症。本文报道了1例因长期大量饮酒而引起的周围神经损害、电解质紊乱及肝功能损害的病例,追查低钾原因发现皮质醇增多,最终诊断为慢性酒精中毒假性皮质醇增多症,分析其发病机制,为提高神经科医师对慢性酒精中毒所致内分泌系统损害及电解质紊乱的认识提供参考。该病例报道已获得病人的知情同意。
患者男,41岁,自由职业,主因“四肢发麻伴手足疼痛半月”于2020年9月13日收入我院神经内科。既往有长期吸烟史20余年,平均20支/d;有长期饮白酒史10余年,平均300~350 g/d (24~27 g酒精量),近2年饮白酒500 g/d (40 g酒精量);有高血压病史2~3年,血压最高160/100 mmHg,口服“硝苯地平控释片”;有冠心病病史半年。患者半月前无明显诱因感四肢发麻伴双手及双足针刺感,程度较轻,症状持续;3 d前患者饮酒量明显增加后出现恶心、呕吐伴有双手及双足针刺感明显加重,行走不稳,为进一步诊治入院。病程中无腹痛、腹泻,无言语不清、肢体无力、饮水呛咳、吞咽困难。急诊血气分析钾2.53 mmol/L (正常值3.5~5.5 mmol/L)、氯93 mmol/L (正常值98~107 mmol/L)、离子钙1.072 mmol/L (正常值1.12~1.32 mmol/L)、pH 7.453 (正常值7.35~7.45)、二氧化碳分压4.31 kPa (正常值4.67~6 kPa)、阴离子间隙22.4 mmol/L (正常值8~16 mmol/L)、乳酸5.7 mmol/L (正常值0.4~2.2 mmol/L)、氧饱和度96.7% (正常值91%~99%),拟“低钾原因待查”收住入院。患者发病以来神志清楚,精神稍差、食欲差、睡眠不佳、大小便正常,体重无明显改变。体格检查:体温36.5℃,脉搏78次/min,呼吸16次/min,血压BP134 mmHg/90 mmHg,神经系统查体:颅神经查体正常,四肢肌力肌张力正常,无肌肉萎缩,双上肢腱反射正常,双下肢腱反射消失,双侧针刺觉对称,深感觉正常,双侧巴氏征阴性,双侧指鼻试验及跟膝胫试验正常,颈软,克氏征阴性,闭目难立征阴性。辅助检查:电解质:镁0.57 mmol/L (正常值0.75~1.02 mmol/L)、血钾2.79 mmol/L (3.5~5.1),氯90.1 mmol/L (98~107);皮质醇(8:00, 16:00, 24:00):910.000 nmol/L (正常值166~507 nmol/L)、398 nmmol/L (正常值73.8~291 nmmo/L)、504.000 nmol/L,促肾上腺皮质激素(08:00) 7.44 pmmol/L (正常值1.6~13.9 pmmol/L),甲状旁腺激素0.83 pmmol/L (1.6~6.9 pmmol/L);同型半胱氨酸77.2 μmol/L (正常值3~15 μmmol/L)、总胆红素:36.5 μmol/L(正常值3~22 μmol/L)、间接胆红素19.14 μmol/L (正常值0~19 μmol/L)、尿酸510.4 μmol/L (正常值208~506 μmol/L),淀粉酶150.4 U/L (正常值30~110 U/L),脂肪酶602.7 U/L(正常值23~300 U/L),谷草转氨酶168.4 U/L (正常值17~59 U/L)、谷氨酰转肽酶1081.9 U/L (正常值15~73 U/L)、淀粉酶150.4 U/L (正常值30~110 U/L)、脂肪酶602.7 U/L (正常值23~300 U/L),随机血糖6.27 mmol/L (正常值4.1~5.9 mmol/L)、总胆固醇5.26 mmol/L (正常值 < 5.18 mmol/L);尿常规:尿蛋白2+,隐血2+,尿胆原3+,尿红细胞102.3个/ul (正常值0~23个/ul),白细胞56.8个/ul(正常值0~25个/ul),尿红细胞形态均一红细胞;醛固酮、肾素、血管紧张素I、血管紧张素II、肾上腺素、去甲肾上腺素、多巴胺、甲状腺功能、叶酸、维生素B12正常,乙肝、丙肝、梅毒、HIV抗体、自身抗体及抗中性粒细胞抗体均阴性。心电图:窦性心动过速,ST-T异常(I、II、III、aVF、V2~V6导联ST段压低达0.05~0.1 mV,II、III、aVF、V4~V6导联T波低平或倒置)。颅脑MRI示小脑萎缩、垂体MRI未见明显异常。胸腹部CT平扫 + 增强:左侧输尿管上段、下段结石伴上游输尿管扩张积水,周围少许渗出;左肾占位,考虑为血管平滑肌脂肪瘤;右肾复杂性囊肿;脂肪肝;升结肠管壁周围多发小憩室;前列腺钙化灶。B超:心脏、双肾血管正常,甲状腺双侧叶结节性甲状腺肿,左侧颈部动脉斑块形成,脂肪肝。神经传导速度四肢周围神经病变(累及部分运动,感觉神经传导,下肢更严重,感觉神经受累广泛),双胫神经F波潜伏期正常,双尺神经F波潜伏期延长,肌电图未见异常。神经心理检查简易精神状态检查表 [
慢性酒精中毒导致的假性皮质醇增多症(Pseudo-Cushing’s syndrome, PCS)至今全世界不超过70篇文献报道。我国目前仅有一例文献报道,该病的特点是皮质醇在各时间点增高但节律正常,戒酒后1周至1月左右皮质醇可恢复正常,排除真性皮质醇增多的病因(如库欣病、异位ACTH分泌综合征、肾上腺皮质腺瘤或癌及肾上腺皮质增生等)及其他假性皮质醇增多的病因(重度抑郁症、血糖控制不佳的糖尿病、多囊卵巢综合征、肥胖症、肾功不全等) [
慢性酒精中毒常见的并发症之一是周围神经病(Alcoholic peripheral neuropathy, AN)。临床主要表现为四肢感觉异常(下肢重于上肢,远端重于近端)、运动乏力、自主神经症状,病程迁延,典型的神经电生理改变为长度依赖性感觉运动轴索型周围神经病。其发病机制仍有争议,目前认为主要原因有酒精的神经毒性、营养缺乏(尤其是硫胺素和B12)、肝功能异常、酒精饮料中的杂质(如铅)、血糖紊乱等 [
低血钾和低血镁是慢性酒精中毒常见的并发症之一,与进食减少、恶心、呕吐导致钾和镁的摄入减少和排出增多有关。低镁可致肾小管钠钾ATP酶(Na-K-ATPase)功能障碍,细胞摄入钾减少,尿钾排泄增多;同时皮质醇增多也可导致尿排钾增多,加重低血钾,故对低钾患者补镁有利于血钾的恢复 [
慢性酒精中毒除导致周围神经损害、内分泌和电解质异常、肝功能损害外,还导致慢性酒精中毒性脑病(韦尼克脑病、科萨科夫综合症、胼胝体变性、小脑变性、痴呆、谵妄、癫痫、精神和行为异常) [
综上所述,慢性酒精中毒常导致中枢及周围神经系统损害、电解质紊乱、肝脏损害、极少导致假性皮质醇增多症。对有慢性酒精中毒合并电解质紊乱的患者,建议完善下丘脑–垂体–肾上腺轴相关激素、甲状旁腺素检查,明确病因,及时纠正血镁、血钾。
罗 容,肖佩荣. 慢性酒精中毒假性皮质醇增多症一例Hypercortisolism Caused by Alcohol Abuse: A Case Report[J]. 临床医学进展, 2021, 11(03): 1405-1408. https://doi.org/10.12677/ACM.2021.113201