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【专题】《Clinical Chemistry》2015年11月病例学习（结果公布）

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这个帖子发布于4年零363天前，其中的信息可能已发生改变或有所发展。

【病例翻译须知】
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4、翻译时请参照版规：关于《Clinical Chemistry》杂志“临床病例学习”栏目翻译讨论活动的意见征集 - 丁香园论坛5、在首位认领战友未超过规定时间的其他任何认领属违规认领，将不会给予丁当或加分！
A Patient with Persistent Lactation and Recurrent Hypercalcemia
CASE DESCRIPTION
An 18-year-old woman presented with persistent bilateral lactation, excess body weight, and
recurrent hypercalcemia. At age 13 years, before menarche, she developed bilateral milk
discharge from her breasts. The lactation continued and, at age 16 years, she experienced
increasingly frequent headaches and visual field changes; her prolactin concentration was noted
to be >2400 ng/mL. A year later, she underwent transsphenoidal resection of a pituitary
macroadenoma. After the surgery, she developed panhypopituitarism and central diabetes
insipidus (DI). She was treated with levothyroxine (T4) for secondary hypothyroidism and
received other hormone replacement therapy, including desmopressin acetate [a synthetic analog
of antidiuretic hormone (ADH)], conjugated estrogen (Premarin), growth hormone (Humatrope),
and bromocriptine. A year later, she developed recurrent kidney stones and was diagnosed with
primary hyperparathyroidism. She was also found to have multiple thyroid nodules. She
underwent a 4-gland parathyroidectomy with left forearm autograft and total thyroidectomy.
She had had transient hypoparathyroidism following parathyroidectomy, soon afterward she
experienced recurrent primary hyperparathyroidism with nephrocalcinosis and pyelonephritis.
She came to our hospital to seek further evaluation and treatment. She had continued to gain
weight and had developed depression and anxiety. She also reported joint pain, fatigue, blurry
vision, loss of appetite, dyspnea, polyuria, and insomnia. She reported occasional diarrhea but no
significant flatulence. There was no pertinent family history of endocrine disorders. Physical
examination revealed an obese young woman in distress, with leg swelling and unbalanced gait.
Her pulse was 91 beats per minute and blood pressure was 113/67 mmHg. Findings of the
cardiovascular and respiratory examination were unremarkable. Multiple skin tags and nodules
were noted over the trunk and abdomen and around her vaginal and groin region. The evaluation
at our institution included laboratory investigations (Table 1), imaging, and histologic studies. An
adrenocorticotropic hormone (ACTH) stimulation test (1 µg cosyntropin) showed a peak cortisol
concentration of 18.7 µg/dL (reference interval >20 µg/dL). Complete blood cell count showed
microcytic hypochromic anemia.

CCS_November_2015.pdf(157.94k)

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2015-10-02 15:22 浏览 : 1608 回复 : 7

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祖国的花朵小白白编辑于 2015-10-29 18:07

• 下午四点不见不散

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认领本病例翻译，如果72小时内未完成，请其他战友认领。

2015-10-06 16:35

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• 脑部急诊常见典型病例，每个影像科医生都要掌握，已公布结果，哪位站友能总结一下？

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一名持续性泌乳伴反复高钙血症的病人

病例描述
一名18岁的女性，表现为双侧乳房持续性泌乳，过度肥胖和反复高钙血症。在初潮之前，13岁的时候她发现双侧乳房有乳汁流出，为持续性泌乳。16岁的时候出现日益频发的头痛和视野的改变，这时她的催乳素浓度>2400 ng/mL。一年后，她接受了经蝶骨垂体大腺瘤切除术，术后发生了全垂体功能减退和中枢性尿崩（DI）。服用左旋甲状腺素（T4）治疗继发的甲状腺功能减退，并接受其它的激素替代治疗，包括醋酸去氨加压素[一种人造的抗利尿激素（ADH）的类似物]、结合雌激素（普雷马林）、生长激素（优猛茁）和溴麦角环肽（溴隐亭）。一年后，出现反复肾结石，诊断为原发性甲状旁腺功能亢进，同时发现甲状腺有多个结节，接受了甲状旁腺全切加左前臂自体移植术和甲状腺全切术。
甲状旁腺切除术后，出现过短暂的甲状旁腺功能减退，不久后出现反复性的原发甲状旁腺功能亢进，并伴有肾钙质沉着和肾盂肾炎。为了进一步评估和治疗，遂来我院就诊。她的体重继续增加，开始出现抑郁和焦虑。自诉有关节疼痛、疲乏、视物模糊、食欲不振、呼吸困难、多尿和失眠。没有相关的内分泌紊乱的家族史。体格检查提示她是一名严重肥胖的青年女性，下肢肿胀，步态失衡。脉搏91/min，血压113/67mmHg。心血管和呼吸系统检查无特殊。在她的躯干和腹部，阴道周围和腹股沟区发现了多种皮垂和结节。我院的评估包括实验室检查（表1）、影像和病理检测。促肾上腺皮质激素（ACTH）刺激试验（1µg促皮质素）显示皮质醇的最大浓度是18.7 µg/dL（参考范围>20 µg/dL）。全血细胞计数显示小细胞低色素贫血。
表1

检测项目	结果	参考范围
甲状旁腺激素，全段，pg/mL	986	9-80
钙，mg/dL	10.6	8.4-10.2
25-羟基维生素-D，ng/mL	15	30-100
催乳素，ng/mL	92.2	4.8-23.3
生长激素，ng/mL	﹤0.01	0.01-3.61
胰岛素样生长因子，ng/mL	50	117-321
胰岛素，mIU/mL	105	2.0-29.1
胰岛素原，pmol/L	300	3-20
促甲状腺激素，µIU/mL	﹤0.01	0.27-4.20
游离T₄_，ng/dL	0.99	0.93-1.70
卵泡刺激素，mIU/mL	﹤0.1	3.5-12.5
黄体生成素，mIU/mL	﹤0.7	1.0-11.4
雌二醇，pg/mL	29	15-350
促肾上腺皮质激素，pg/mL	﹤5	5-46
皮质醇，µg/dL	2.0	4.3-22.4
嗜铬粒蛋白A，ng/mL	1263	≤93
胰多肽，pg/mL	343	小于等于249
胃泌素，pg/mL	584	﹤100
钠，mmol/L	142	136-146
渗透压，mOsm/kg	301	289-308
尿渗透压，mOsm/kg	255	500-850
尿比重	≤1.005	1.005-1.030