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目的 研究异位ACTH综合征的临床特点 ,提高早期诊断和降低误诊、误治率。方法 回顾性分析我院 1998年 1月～ 2 0 0 3年 2月收治的异位ACTH综合征的临床特点、影像学检查在诊断过程中的作用 ,并与低血钾库欣病进行比较。结果 (1)异位ACTH综合征占同期皮质醇增多症的 11.3 % ,常见病因是肺癌和支气管类癌 ;(2 )异位ACTH综合征多见于男性 (M :F =5 :3 ) ,确诊时年龄大 ,病程在 5个月之内 ,病情进展快 ,常常伴有肌萎缩和肌无力 ,下肢水肿 ;(3 )血清ACTH和血浆皮质醇 (F)水平更高 ,大剂量地塞米松抑制试验阴性率更高 ,代谢性碱中毒更严重 ;(4 )胸部平片和CT检查能发现多数病变 ;(5 )预后取决于肿瘤的性质 ,手术完全切除病灶是关键。结论 综合临床特点、动脉血气、血清钾和激素水平、胸部平片及CT检查有助于鉴别异位ACTH综合征和库欣病伴低血钾
Objective To study the clinical features of ectopic ACTH syndrome, improve the early diagnosis and reduce misdiagnosis and misdiagnosis rate. Methods The clinical features of ectopic ACTH syndrome treated in our hospital from January 1998 to February 2003 were retrospectively analyzed. The role of imaging in the diagnosis was compared with that of Cushing’s disease with low serum potassium. Results (1) Ectopic ACTH syndrome accounted for 11.3% of the same period cortisol hypersecretion, common causes of lung cancer and bronchial carcinoid; (2) ectopic ACTH syndrome more common in men (M: F = 5: 3) (3) serum ACTH and plasma cortisol (F) levels were higher, high-dose dexamethasone inhibition Test negative rate is higher, more severe metabolic alkalosis; (4) chest plain film and CT examination can detect most lesions; (5) the prognosis depends on the nature of the tumor, complete removal of the lesion surgery is the key. Conclusion The comprehensive clinical features, arterial blood gas, serum potassium and hormone levels, chest plain film and CT examination can help identify ectopic ACTH syndrome and Cushing’s disease with hypokalemia