小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 疲劳
- 厌食
- 体重减轻
- 色素过度沉着
- 嗜盐症
其他诊断因素
- 恶心
- 呕吐
- 低血压
- 关节痛和肌痛
危险因素
- 女性
- 肾上腺皮质自身抗体
- 肾上腺出血
- 自身免疫性疾病
- 结核病 (TB)
- 非结核菌感染
- 真菌感染
- HIV
- 抑制皮质醇分泌的药物
- 转移性恶性肿瘤
- 乳糜泻
- 结节病
诊断性检查
首要检查
- 血清电解质
- 血尿素
- 全血细胞计数（FBC）
- 清晨血清皮质醇
需考虑的检查
- 促肾上腺皮质激素 (ACTH) 刺激试验
- 血清 ACTH
- 血浆肾素活性
- 血浆醛固酮
- 血浆脱氢表雄酮 (DHEA)
- 血浆硫酸脱氢表雄酮 (DHEAS)
- 肾上腺抗体
- 肾上腺 CT 或 MRI 检查
- 胰岛素低血糖试验
- 隔夜单次剂量美替拉酮试验
治疗流程
肾上腺危象
病情稳定和/或进行急性发作期治疗后
撰稿人
作者
T. Joseph McKenna, MD, FRCPI, FRCP, FRCPEdin
Professor Emeritus and Honorary Consultant
Department of Endocrinology and Diabetes Mellitus
St. Vincent’s University Hospital
Dublin
Ireland
利益声明
TJMcK declares that he has no competing interests.
鸣谢
Dr T. Joseph McKenna would like to gratefully acknowledge Dr Shehzad Basaria and Dr Milena Braga-Basaria, previous contributors to this topic.
利益声明
SB and MBB declare that they have no competing interests.
同行评议者
Baha Arafah, MD
Division of Endocrinology
Case Medical Center
Cleveland
OH
利益声明
BA declares that he has no competing interests.
Rajesh K. Garg, MD
Professor of Medicine
Director of Clinical Diabetes
University of Miami
Miami
FL
利益声明
RKG declares that he has no competing interests.
Antoine Tabarin, MD
Head
Department of Endocrinology
Centre Hospitalier Universitaire de Bordeaux
Pessac
France
利益声明
AT declares that he has no competing interests.
Blandine Gatta-Cherifi, MD
Department of Endocrinology
Centre Hospitalier Universitaire de Bordeaux
Pessac
France
利益声明
BGC declares that she has no competing interests.
鉴别诊断
- 皮质类固醇治疗抑制肾上腺
- 继发性或三发性肾上腺皮质功能减退（垂体或下丘脑病变）
- 血色病
更多 鉴别诊断指南
- 肾上腺皮质功能不全和 Addison 病
- 成人患者急性肾上腺皮质功能不全（肾上腺危象）的紧急治疗
更多 指南患者教育信息
Addison's disease: what is it?
Addison's disease: what treatments work?
更多 患者教育信息
登录或订阅即可浏览 BMJ Best Practice 临床实践完整内容
内容使用需遵循免责声明