第一临床医学院知识库

目的：讨论垂体功能减退危象的临床特点及诊治。方法：收集1例垂体功能减退危象患者的病历资料及诊疗过程，进行病例报告及文献复习。病史：患者垂体瘤术后26年，2013年于我科明确诊断为垂体功能减退，此次因受凉、劳累、自行药物减量后，咳嗽、咳痰、反应迟钝、血压偏低。入院后高热、嗜睡，继而出现昏迷、血压降低、电解质紊乱、血氧饱和度难以维持等垂体危象表现。治疗：给予大剂量氢化可的松、甲状腺激素抢救垂体危象；呼吸机辅助呼吸、抗感染治疗肺炎。结果：患者意识转清，血压、心率、血氧饱和度平稳，垂体危象纠正、肺部感染控制好转出院。出院后继续激素替代治疗。结论：垂体功能减退患者在各种应激或突然停药（减药）等情况下可诱发垂体危象，危及生命，属于临床极危重症，诊疗应及时有效。垂体功能减退的早期症状往往表现不明显，尤其在老年患者中，易误诊、漏诊，临床上应加强对该病的认识，并强调诊断后激素替代治疗的重要性。

Objective: To investigate the clinical characteristics, diagnosis and treatment of hypopituitarism crisis.Methods: A case report about a patient who suffered from hypopituitarism crisis is presented, and related literatures are reviewed.History: The patient has a history of pituitary adenoma surgery and then she was diagnosed with hypopituitarism in our department in 2013. Several days before this hospital admission, the patient suffered a cold in the travel and reduced the drug dosage. After admission, the patient presented with high fever, lethargy, coma, decreased blood pressure, electrolyte disturbance, low oxygen saturation, which were eligible for the diagnosis of hypopituitarism crisis.Treatment: High dose hydrocortisone and thyroid hormone was given to treat pituitary crisis, and antibiotics was prescribed for pulmonary infection, mechanical ventilation was employed as well.Results: The patient was turned conscious, and blood pressure, heart rate, oxygen saturation become steady, pituitary crisis was corrected, pulmonary infection was controlled. Hormone replacement therapy sustained after discharge.Conclusion: Patients with hypopituitarism can cause pituitary crisis under many circumstances, such as various stress or sudden withdrawal of drugs and so on, which will be life-threatening and belongs to the clinical critical disease, diagnosis and treatment should be timely and effective. The early symptoms of hypopituitarism are often not obvious, especially in the elderly patients, it is easy to misdiagnose, so clinicians should strengthen the understanding of the disease, and emphasize the importance of hormone replacement therapy after diagnosis.