酒精成瘾诱发的假性库欣综合征一例报道及文献复习

目的报道1例由慢性酒精成瘾诱发的假性库欣综合征,以扩展临床医师对酒精危害及其导致疾病谱的认识。方法对本院发现的1例假性库欣综合征病例的病因进行分析,其临床特点进行对比观察,国内外相关文献报道进行复习总结。结果患者入院后发现皮质醇增多,小剂量地塞米松抑制试验不被抑制,大剂量地塞米松抑制试验被抑制。垂体、肾上腺及其他部位都未发现占位性病变。戒酒后20d皮质醇水平恢复正常,规律随访半年,皮质醇水平及节律无明显异常。诊断为假性库欣综合征。文献复习结果筛选出65篇相关病例报道,对65篇文献报道的慢性酒精成瘾诱发的假性库欣综合征与库欣综合征临床症状和体征进行分析总结,结果只在肌肉萎缩及乏力和中心性肥胖等方面发现了微细差别。结论长期大量饮酒可通过多种机制诱发假性库欣综合征,与真性皮质醇增多症的鉴别比较困难,临床上需结合患者的临床表现、体格检查以及实验室检查结果与库欣综合征进行鉴别,其中重要的方法是通过观察检测戒酒后的一些生化学检查指标进行鉴别和确诊,以防造成误诊而致过度医疗。

Clinical analysis of one patient with pseudo-Cushing's syndrome induced by alcohol abuse and review of literature

Abstract: Objective A case of pseudo-Cushing''s syndrome induced by chronic alcohol abuse was reported to expand clinicians'' awareness of alcohol abuse. Methods The etiology of a patient with pseudo-Cushing''s syndrome found in our hospital was analyzed, and its clinical characteristics were compared. The review of related literature reports at home and abroad was reviewed. Results Patient was found to have increased cortisol after admission, and both low-dose and high-dose dexamethasone suppression tests were not inhibited. No space-occupying lesions were found in the pituitary, adrenal gland, and other areas. Cortisol levels returned to normal after 20 days of alcohol withdrawal. Regular follow-up for half a year, no significant abnormalities in cortisol levels and rhythm. Diagnosed as pseudo-Cushing''s syndrome. The literature review results screened 65 relevant case reports. Conclusion Long-term excessive drinking can induce pseudo-Cushing''s syndrome, and the identification with true hypercortisolism can be confirmed by observing some biochemical tests after alcohol withdrawal.