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以顽固性低钾血症为首发症状的 MRI阴性库欣病一例

Value of bilateral inferior petrosal sinus sampling for preoperative diagnosis of adrenocorticotropic hormone microadenomas

ObjectiveTo explore the value of bilateral inferior petrosal sinus sampling (BIPSS) for preoperative diagnosis of adrenocorticotropic hormone (ACTH) microadenomas.MethodsWe retrospectively analyzed the clinical date of patients with ACTH microadenomas, who were experienced BIPSS preoperatively from October 2013 to May 2017. The qualitative and localized diagnostic significance of BIPSS was evaluated based on the criteria of the plasma ACTH concentration ratio of inferior petrosal sinus to ulnar vein (≥2), and the ratio of left to right inferior petrosal sinuses (≥1.4).ResultsFive patients (1 male and 4 females) were involved in the study. The mean age was (49.6±9.2) years, and the mean disease course was (17.2±7.5) months. The plasma ACTH concentration of all the cases ran up to the criterition of the ratio of inferior petrosal sinus to ulnar vein (≥2). Three cases were found that the actual locations of the microadenomas were inconsistent with the indications from the results of BIPSS. After the BIPSS procedure, there was no intracranial infection or death case, except that one patient suffered from ecchymoma and another one suffered from transient nausea.ConclusionBIPSS is valuable for qualitative diagnosis, but not effective for localization diagnosis of the ACTH microadenomas preoperatively.

库欣病合并肺栓塞一例并文献复习

目的 总结分析库欣综合征（Cushing syndrome，CS）合并静脉血栓栓塞症（venous thromboembolic events，VTE）的发病机制、临床风险评估及治疗，提高临床医师对此并发症的认识。方法 报道1例库欣病（Cushing disease，CD）合并肺栓塞患者的临床诊治经过，并复习国内外相关文献。结果 患者31岁，女性，确诊CD，行鞍区占位切除术，术后第6天肺动脉血管三维重建增强计算机断层扫描（computed tomography angiography，CTA）提示肺栓塞，先后予以低分子肝素及利伐沙班抗凝治疗，3个月后复查肺动脉CTA未见异常。以“库欣病、库欣综合征”与“肺栓塞、静脉血栓栓塞症”为关键词检索万方医学数据库、中国知网医学数据库和维普网数据库，国内仅3篇相关文献。检索pubmed数据库，共检索到相关文献73篇其中28篇个案报道，10篇综述，35篇临床研究文章。CS发生VTE风险比普通人群高10余倍，发病机制及临床风险评估复杂，预防抗凝时间及方案尚未达成共识。结论 CS发生VTE的风险显著升高，起病急，病死率高。临床上需警惕、避免、甄别CS相关并发症，做到早诊断、早治疗。