Objective:To explore the clinical features and main points of diagnosis and treatment about adrenal crisis(AC),so as to reduce the missed diagnosis,misdiagnosis and wrong treatment in the clinical work.Methods:The clinical data of one patient with AC following esophageal cancer surgery were analyzed retrospectively,and the process of clinical diagnosis and treatment of AC were summarized.Results:A 49-year-old male patient was admitted due to fever 3 weeks after esophageal cancer surgery,identified with anastomotic leakage,and treated with multiple antibiotics which showed poor anti-infection effect over a long period of time.Moreover,the patient experienced intermittent high fever and decreased blood pressure even after the fistula healing,responded well to the hormone with defervescence,while was gradually fatigue and bedridden after dose reduction and discontinuation.No evidence of tumor recurrence was found by the enhanced computed tomography(CT)with contrast,while significantly decreased levels of cortisol and adrenocorticotropic hormone(ACTH)were revealed in the laboratory test.The patient was diagnosed with the immunotherapy-related hypophysitis,which led to AC,based on the pre-operative application of programmed death receptor 1(PD-1)inhibitors,and was discharged upon improvement with supplementary prednisone.Conclusion:As a critical internal medical condition,AC has non-specific clinical manifestations and is very easily vulnerable to missed diagnosis,misdiagnosis and wrong treatment,thus should be emphasized for clinicians to increase their understanding so as to achieve early diagnosis and timely treatment with glucocorticoid.
关键词
肾上腺危象/急性肾上腺皮质功能不全/脓毒症/促肾上腺皮质激素/程序性死亡受体1
Key words
adrenal crisis/acute adrenocortical insufficiency/sepsis/adrenocorticotropic hormone/programmed death receptor 1
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