摘要
目的探讨自身免疫多内分泌腺病综合征-3型(autoimmune polyendocrine syndrome,APS-3)的临床特点。方法总结1例APS-3型女性患者的临床经过,并进行文献复习。结果患者先后出现慢性淋巴细胞性甲状腺炎、1型糖尿病反复出现低血糖,通过糖皮质激素替代治疗,血糖控制稳定,入院查24h UFC、血ACTH、血F在正常范围,但兴奋实验不被兴奋。其它免疫指标:抗SSA抗体(+),抗SSB抗体(-),ANA(+)。最终诊断APS-3。结论 APS-3临床表现各异,该患者主要表现血糖波动大,皮质醇储备功能差,同时还存在生长激素的缺乏,血糖的波动,除需考虑胰岛素用量问题、原发肾上腺皮质功能减退等因素外还要注意有无继发肾上腺皮质功能减退的可能。
Objective To improve the understanding of APS.Methods A 46-year-old woman who was diagnosed to have chronic lymphocytic thyroiditis 15 years ago and type 1 diabetes mellitus 10 years ago had well controlled blood sugar level until recent one year.Her blood sugar fluctuated remarkably with the same treatment as one year ago.Laboratory test showed that she was euthyroid with positive thyroid antibodies,GAD positive with 1DM,while the 24h UFC,adreno-corticotropin （ACTH）,plasma cortisol （8am） were normal,anti-adrenal antibody was negative.Her serum anti-SSA antibody was positive and ANA was positive,too.Results This patient was diagnosed with chronic lymphocyticthyroiditis,type1 diabetes mellitus,autoimmune hypophysitis and Sj O gren＇s syndrome.Autoimmune polyglandular syndrome type-3 could be diagnosed based on these data.Her blood sugar was well controlled by replacement of fludrocortisone.Conclusions When a patient＇s blood sugar fluctuates remarkably,secondary hydrocortisone should be considered besides poor insulin response and Addison＇s disease.
出处
《北京医学》
CAS
2011年第4期295-297,共3页
Beijing Medical Journal
