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谢某某,女,44岁,患者于1974年始自觉乏力、纳减、头昏、皮肤及口腔粘膜黑褐色色素沉着,晕厥数次,查血压低。住当地医院查尿17-羟,17-酮低,诊断阿狄森氏病,长期中药治疗。今年2月无明显诱因出现易饥、怕热、烦躁、失眠、双眼胀痛,伴有腹泻,体重下降4kg,颈前肿大。否认结核病史。查体:体温36.5℃,脉搏80次/分,血压14.6/8.6kPa,体重38kg。毛发分布正常,皮肤色素稍深,尤以唇,牙齿,颊粘膜有黑褐色色素沉着。双眼球微突,炯炯有神,眼征(-),甲状腺Ⅰ°大,质软,未闻及血管杂音,心、肺、腹、神经系(-)。血及尿常规,肝功能正常,血糟4.2mmol/L,血钾4.8mmol/L,血钠144mmol/L,血氯100mmol/L血清总T_3 273.1ng/dl,总T_4 12.9μg/dl,尿17-羟2.33ung/24h,17-酮4.3μg/24h,促肾上腺皮质激
Xie Moumou, female, 44 years old, the patient began to feel weak in 1974, reduced, dizziness, skin and oral mucosa dark brown pigmentation, syncope several times, check the blood pressure is low. Live in the local hospital check urine 17-hydroxy, 17-ketone low, diagnosis Addison’s disease, long-term Chinese medicine treatment. No obvious incentive in February this year, easy to starve, afraid of fever, irritability, insomnia, binocular pain, accompanied by diarrhea, weight loss 4kg, neck anterior enlargement. Denied the history of tuberculosis. Physical examination: body temperature 36.5 ℃, pulse 80 beats / min, blood pressure 14.6 / 8.6kPa, weight 38kg. Normal hair distribution, the skin pigment slightly darker, especially lips, teeth, buccal mucosa with dark brown pigmentation. Eyes are slightly protruding, piercing, eyelid (-), thyroid Ⅰ ° large, soft, no smell of vascular murmur, heart, lung, abdomen, nervous system (-). Blood and urine routine, normal liver function, blood 4.2mmol / L, serum potassium 4.8mmol / L, serum sodium 144mmol / L, serum chloride 100mmol / L total serum T_3 273.1ng / dl, total T_4 12.9μg / dl, urine 17-hydroxy 2.33ung / 24h, 17-keto 4.3μg / 24h, adrenocorticotropic shock