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一、本例诊断为原发性肾上腺皮质功能减退症(Addison’s disease——爱迪森氏病)并发原发性甲状腺功能减退症。肾上腺皮质主要分泌糖皮质激素与盐皮质激素,原发性肾上腺皮质功能减退症的肾上腺皮质绝大部分遭到破坏,临床主要表现糖与盐皮质激素不足。纳差、乏力常常是本症的早期症状。糖皮质激素不足可导致胃液量、胃酸度与胃蛋白酶含量降低及肠吸收功能下降。患者常有明显食欲不振,严重时恶心、呕吐甚至腹泻。糖皮质激素不足使糖原异生减少,加上进食不足可导致空腹血糖降低。本例入院时血糖即为40毫克%。长期进食不足造成体内氮负平衡,再加上呕吐脱水与电解质紊乱,使患者明显乏力、消瘦。本例入院时体重仅38公斤。
First, this case was diagnosed as primary adrenocortical hypothyroidism (Addison’s disease) complicated with primary hypothyroidism. The adrenal cortex mainly secretes glucocorticoids and mineralocorticoids, and the majority of the adrenal cortices in primary adrenocortical hypofunction are destroyed. The main clinical manifestations are lack of sugar and mineralocorticoid. Anorexia, fatigue is often the early symptoms of this disease. Lack of glucocorticoids can lead to gastric juice volume, gastric acidity and pepsin levels decreased and intestinal absorption decreased. Patients often have significant loss of appetite, severe nausea, vomiting and even diarrhea. Inadequate glucocorticoids reduce gluconeogenesis, coupled with undernourishment, can result in impaired fasting glucose. This case of blood glucose at admission is 40 mg%. Long-term lack of intake of nitrogen in the body caused by negative balance, coupled with vomiting dehydration and electrolyte imbalance, so that patients obviously weakness, weight loss. In this case admitted to weight only 38 kg.