The cortex function of renal gland does not cause _'s symptom of atrio-ventricular block completely

The cortex function of renal gland does not cause _'s symptom of atrio-ventricular block completely
It is mainly shown as aldosterone lacking and cortisol is scarce that the cortex function of renal gland is not complete, it can cause multi system symptom, for instance that cortisol lacks: Receive difference, weak, diarrhoea, abdominal distension, indigestion, mind is indifferent, the abnormal state of hypotension and skin mucomembranous pigmentation and reproduction endocrine system, check and find low sodium, low chlorine, hypoglycemia in the laboratory. May develop into crisis of renal gland under should surge the situation to wait for to infecting. The intersection of example and patient this have renal the intersection of operation and history previously, appear skin pigmentation and weak and receiving difference promptly while being postoperative, get up this time disease present the intersection of digestive tract and symptom of vomiting, suffering from diarrhoea etc., combine the laboratory, check ACTH, rise obviously, can diagnose and fail in chronic original renal gland cortex function disease.
A case materials
Patient, female, 72 year old, " vomit, dizzy 2h " Admitted to hospital on December 20, 2002. Patient's reason more than 20 years ago " Right kidney stone " " the right kidney cuts and fetches the stone skill " to walk ,Appear skin pigmentation of whole body gradually while being postoperative, the companion is weak, receives difference slightly, have not made a diagnosis and given treatment. During the last 1 weeks the above-mentioned symptom became more serious, and it is disgusting and vomiting, suffering from abdominal pain, suffering from diarrhoea to appear. Eat waters for a small amount of porridge every day only,is it bedridden, average and completely mashed 3- 4 times /day,there are little on quantity, one vomits the stomach content thing. Show on the intersection of clinic and competent ECG " 2Visit and go rhythm of the heart, forming ease to fight while forming in the block of sinus room of the degree of Model 2, sinus room " Income institute. Get up disease, have, generate heat, night sweat, without palpitation, shortness of breath, edema, there is not chest that ache, there are not cough, expectoration, becoming thin,etc.. The body is strong in previously, there are not tuberculosis, hepatitis B history, the medical history that overbearing,etc. that there are not heart disease, nephropathy, first. Physical examination: T36.6 , 60 times of P50- min, BP90/50mmHg, R20 time min. God clear, become thin, chronic critical sickly look, lie in bed, the intersection of whole body and the intersection of skin and obvious pigmentation, the lymph node is not reached, the head facial features have no deformity, the neck is soft, the thyroid gland is not swelling, the trachea is between two parties. The thoracic cage has no deformity, one pair of lungs respiration is clear, has not heard and done the wet rale, the heart voiced sound circle shrinks, the heart rate: 50- 60bpm law is not neat, the heart sound is low and blunt, hearing and noise. The belly of boat, soft, the whole belly breaks up in the light tenderness, has not jumped and ached instead, the spleen of liver is not reached, the gurgling sound is normal. The physiology reflects the existence, pathology is solicited and has not drawn. Auxiliary examination: It is checked (mmol/L) that biochemistry is urgent : Na + 113.6, K + 4.6, Cl - 85, CO 2 22, Glu4.7, BUN2.7, the blood, urine routine and liver renal function are basically normal. The patient gives fluid infusion after being admitted to hospital, correct the electrolytic equilibrium disorder, guard the electricity of heart, oxygen intake, resist the treatment to the ill of inflammation. The above-mentioned symptom has not obviously taken a favorable turn, vomit on December 24, suffer from diarrhoea the number of times increase, and the sinus aroused in interest and too slow appears, 58 times of P45- min, BP80/50mmHg, the sinus stops fighting (reach 3s most) . The heart rate can rise to 65 times min, check cortisol (6am) of blood after offering atropine 5mg quiet note 4.7ACTH: 426pg/ml, drafts " the cortex function of renal gland does not combine the crisis earlier stage of renal gland completely " Offer hydrogenation 100mg/8h quiet to drip, treat in cortisone, patient symptom takes a favorable turn gradually, vomit, suffer from abdominal pain and stop on December 25, stool 1- 2 d take shape and quantity little, stomach receive, take a favorable turn slightly, can leave the bed activity, heart cable guards and shows " sinus nature rhythm of the heart " ,The heart rate: 90 times min, law is whole, and BP120/80mmHg presents excited symptom slightly, it is checked (mmol/L) that biochemistry is urgent : Na132.1, C100.3, K2.9, Glu6.6, cortisone of hydrogenation is given decrement gradually, changes into oral prednisone 5mg(8am) on December 28 , 2.5mg(4pm) . Excitement symptom is relieved.
2 is discussed
It is mainly shown as aldosterone lacking and cortisol is scarce that the cortex function of renal gland is not complete, it can cause multi system symptom, for instance that cortisol lacks: Receive difference, weak, diarrhoea, abdominal distension, indigestion, mind is indifferent, the abnormal state of hypotension and skin mucomembranous pigmentation and reproduction endocrine system, check and find low sodium, low chlorine, hypoglycemia in the laboratory. May develop into crisis of renal gland under should surge the situation to wait for to infecting. The intersection of example and patient this have renal the intersection of operation and history previously, appear skin pigmentation and weak and receiving difference promptly while being postoperative, get up this time disease present the intersection of digestive tract and symptom of vomiting, suffering from diarrhoea etc., combine the laboratory, check ACTH, rise obviously, can diagnose and fail in chronic original renal gland cortex function disease. Patient this have the intersection of heart disease and history previously, have illness coming on besides scarce symptom of above-mentioned cortisol amalgamating appear sinus this time room block, sinus room visit, go rhythm of the heart, person who form ease fought form, even presenting the sinus stops fighting and obvious hypotension. By fluid infusion, it is not good to correct the result after dealing with of the electrolytic disorder, the condition has the tendency to aggravate instead, and symptom obviously take a favorable turn after substituting and treating glucocorticoid, the arrhythmia can also be corrected, it is sinus rhythm of the heart to reexamine the electrocardiogram. Function and organic disease that should get rid of the heart at first while meeting the above-mentioned arrhythmia on clinic, the cortex function of renal gland does not cause the heart to change completely mainly: The heart voiced sound circle dwindled, the heart sound is low and blunt [1 ], once there was case report that a cortex function of renal gland did not erupt the malignant room rhythm of the heart not normal [2 ] simultaneously completely at home, but the person who causes block has not appeared in the newspapers and led. The cortex function of renal gland does not lead to the fact completely the mechanism of atrio-ventricular block has not been obvious yet, may relate to the fact that electrolytic disorder and cortical hormone lack the heart caused and conduct the system inhibitorily. Can offer glucocorticoid to substitute treating after getting rid of the intersection of heart and perhaps own disease, first-selected acetic acid cortisone 20- 60mg/d, or prednisone 5- 15mg/d. Can give cortisone of hydrogenation quietly and drip 200- 400mg/d and decrement gradually to take orally when the condition is more serious, curative effect is better. The serious heart rate can be given the treatment to the ill of atropine while passing slowly or stopping fighting.
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