- 期刊
Non-Hodgkin's Lymphoma With Bilateral Adrenal Gland and Brain Involvement Presenting as Primary Adrenal Insufficiency: Report of a Case
開始以腎上腺功能不足表現的兩側腎上腺及腦侵犯之非何杰金氏淋巴瘤：一病例報告
摘要
造成原發性腎上腺功能不足的原因有很多，其中因非何杰金氏淋巴瘤所引起者卻很少見。本文報告一例73歲男性病人，一開始以原發性腎上腺功能不足為表現，在住院當中意外發生急性意識變化和左側偏癱，後而診斷出是合併兩側腎上腺及腦侵犯之非何杰金氏淋巴瘤。由於腎上腺功能不足及惡性腫瘤在臨床上有許多相同的表現，在這些腎上腺功能不足病人的照顧應該更加警惕，及早診斷和治療真正病因，將有助病人整體預後的發展及生活品質的改善。
並列摘要
A 73-year-old man with a history of type 11 diabetes mellitus was hospitalized because of progressive general weakness, anorexia and marked weight loss for 1 month. On admission, lethargy, poor skin turgor and hyperpigmentation of skin were found. Laboratory data showed hyponatremion, anemia and thrombocytopenia. Primary adrenal insufficiency was confirmed by a relative low serum cortisol level during stress test, an elevated adrenocorticotropic hormone (ACTH) level and inadequate response to the rapid ACTH stimulation test. Non-Hodgkin's lymphoma (NHL) of the diffuse large B-cell type with bilateral adrenal gland and brain involvement was diagnosed based on histological study of computerized tomography-guided biopsy of an adrenal mass and emergent craniotomy for a brain tumor with hemorrhage. There Was no evidence of involvement with other organs, the lymphatic system or bone marrow. Steroid replacement therapy was started while workup for adrenal insufficiency proceeded. Whole brain irradiation was performed and he received one course of chemotherapy with cyclophosphamide, vincristine, and prednisolone. He died of aspiration pneumonia complicated with septic shock and progression of NHL 2 months later.
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