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原发性单侧肾上腺结核例并相关文献分析


  熊波波 张劲松 李宁 王海峰 左毅刚 王剑松
  [摘要] 肾上腺结核多继发于肺结核,少见原发性多见双侧同时病变,罕见单侧发病。本文报道了1例原发性单侧肾上腺结核中年男性患者,术前诊断为肾上腺肿瘤可能,术后病理学为肾上腺结核,出院后给予抗结核治疗,后续定期完善随访观察。结合国内外相关文献分析,原发性单侧肾上腺结核患者往往无明显症状,实验室检查指标包括结核菌素试验、血沉、T细胞斑点试验、皮质醇、促肾上腺皮质激素、醛固酮及尿香草扁桃酸等,CT检查方法要优于彩超,肾上腺结核在CT上表现更为清楚,特别对钙化点的识别,术前活检是唯一可以明确疾病性质的方法,常规治疗方式为抗结核治疗或抗结核治疗联合手术。原发性单侧肾上腺结核很少见,应结合患者的影像学资料来鉴别,必要时行穿刺活检术来明确诊断,避免误诊。
  [关键词] 肾上腺结核;肾上腺肿瘤;手术治疗;误诊
  [中图分类号] R529.0          [文献标识码] C          [文章编号] 1673-9701(2019)32-0138-02
  Primary unilateral adrenal tuberculosis of a case report and related literature analysis
  XIONG Bobo ZHANG Jinsong LI Ning WANG Haifeng ZUO Yigang WANG Jiansong
  Department of Urology, Second Affiliated Hospital of Kunming Medical University, Yunnan Institute of Urology, Kunming   650101, China
  [Abstract] Adrenal tuberculosis is mostly secondary to tuberculosis; the primary adrenal tuberculosis is rare; and the bilateral lesions are common; and unilateral morbidity is rare. This article reported one case of middle-aged male patient with primary unilateral adrenal tuberculosis. The preoperative diagnosis was adrenal tumor. And the postoperative pathology was adrenal tuberculosis. Anti-tuberculosis treatment was given after discharge. Follow-up was performed regularly. Combined with domestic and international literature analysis, patients with primary unilateral adrenal tuberculosis often have no obvious symptoms. Laboratory tests include tuberculin test, erythrocyte sedimentation rate, T cell spot test(T-SPOT), cortisol, Adrenocorticotropic hormone(ACTH), aldosterone and vanilla mandelic acid(VMA). CT examination is superior to color Doppler ultrasound. Adrenal tuberculosis is more clear on CT, especially for calcification. Preoperative biopsy is the only method that can clarify the nature of the disease. The conventional treatment is anti-tuberculosis treatment or anti-tuberculosis treatment combined with surgery. Although primary unilateral adrenal tuberculosis is rare, we use the patient"s imaging data to identify, if necessary, a needle biopsy to confirm the diagnosis and avoid misdiagnosis.
  [Key words] Adrenal tuberculosis; Adrenal tumor; Surgical treatment; Misdiagnosis
  腎上腺结核属于泌尿系结核中较少见的临床疾病,继发于肺结核,以双侧同时病变多见,单侧发病罕见[1]。继发性肾上腺结核是结核菌血行播散至肾上腺,破环其皮质及髓质,使肾上腺呈结核性干酪样坏死,当90%以上的肾上腺组织受到严重破环,可导致肾上腺皮质激素分泌不足,出现爱迪生氏病[2]。肾上腺结核是爱迪生氏病的主要病因,肾上腺皮质激素分泌不足,表现为全身多系统的功能紊乱。原发性单侧肾上腺结核患者往往激素分泌不足,相关症状不明显,通常以患侧腰痛为主诉,目前诊断也无统一标准,影像学上与肾上腺肿瘤鉴别相对困难[3],故原发性单侧肾上腺结核在临床上易误诊为肾上腺肿瘤。本文报道了本院收治的1例原发性单侧肾上腺结核的患者,现报道如下。
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