淋巴瘤患者使用大量糖皮質類固醇治療導致戒斷症狀之案例報告

類固醇之戒斷症狀，通常是指疾病在經糖皮質類固醇治療後產生戒斷而復發，或是發生糖皮質類固醇迅速減少或停止時，引起腎上腺功能低下的徵狀。個案為73歲的男性病患，有瀰漫性大型β細胞淋巴瘤，化療後的狀態為第IEA期，因嘔吐淡黃色液體長達3個禮拜而就診。因懷疑化療使用類固醇後之戒斷症狀，先給予methylprednisolone 40 mg/vial每12小時半支，並以症狀治療控制嘔吐現象；而後症狀未改善，因此增加類固醇劑量，給予methylprednisolone 40 mg/vial每12小時1支；而後病患覺食慾不振與經神不佳狀況已改善，故試著快速減少類固醇劑量，改成prednisolone 5 mg/tab每12小時2顆，然而病患卻意識昏沈且無痛覺反應，因此再增加類固醇劑量，改成dexamethasone phosphate 5 mg/ml/amp每12小時0.5支，然後再將類固醇劑量慢慢遞減成較低劑量dexamethasone phosphate 5 mg/ml/amp 每24小時0.5支，病人精神亦較有起色。遞減劑量時得小心，雖遞減的速率有準則可循，但仍須依病人臨床反應而定。

關鍵字

戒斷症狀；腎上腺功能低下；皮質醇

並列摘要

Steroid withdrawal syndrome (SWS) usually refers to relapse of the disease being treated after withdrawal of glucocorticoid therapy, or the symptoms of adrenal insufficiency. SWS often occurs when glucocorticoids are suddenly reduced or stopped. This is a 73-year-old man who has been diagnosed diffused large β-cell lymphoma, stage IEA and ever received chemotherapy and high dose glucocorticoid therapy, was admitted for experienced vomiting with light yellowish liquid material when moving for 3 weeks. Doctor prescribed methylprednisolone 20 mg q12h on account of suspecting adrenal insufficiency and kept symptomatic control for continual vomiting with coffee-ground. Then increasing steroid dose to 40 mg q12h was performed for his persisted weakness and poor appetite. After increasing dose, the appetite and spirit improved. Doctor tried to tapper methylprednisolone to prednisolone 10 mg q12h rapidly. However, the patient consciousness became drowsy and had no pain response. Therefore, doctor added back steroid and changed methylprednisolone to dexamethasone 2.5 mg q12h. Then, doctor tapered steroid to lower dose again very slowly and according to clinical response. Conclusion: Tapering steroid should be done carefully and the rate of reduction should depend upon the clinical responses.

並列關鍵字

Withdrawal syndrome ； Adrenal insufficiency ； Cortisol

國際替代計量

淋巴瘤患者使用大量糖皮質類固醇治療導致戒斷症狀之案例報告

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