胃潰瘍と糖尿病を合併したAddison病の1例

A Case of Addison's Disease Complicated with Gastric Ulcer and Diabetes Mellitus

　従来，Addison病は消化管潰瘍病変の少ない疾患として知られているが，近年ステロイド治療中潰瘍が合併しやすいことが警告されている．われわれは，最近ハイドロコーチゾン維持療法中に胃潰瘍と糖尿病を合併した1例を経験し，治療上問題点も多い症例であったので，文献的考察を加えて報告する．

　A 68-year-old woman first visited in 1970 the Department of Dermatology, School of Medicine, University of Kanazawa, because of brownish pigmentation in her face, hands, and tibial regions associated with appetite-loss, weight-loss and general malaise. Since then she was treated with hydrocortisone with a dose of 30 mg a day under a diagnosis of Addison's disease. Under this regimen her subjective symptoms and pigmentation improved. In 1971, during replacement therapy with hydrocortisone, she complained of epigastric pain. Roentgenologic examination of the stomach at this time revealed a gastric ulcer on the posterior wall of the upper corpus. The epigastric pain subsided by medical management. Since November 1973, she again complained at times of epigastric pain and was admitted to our Clinic in August 1974.

　Endocrinological examinations consisted with the diagnosis of Addison's disease associated with overt diabetes which had not been pointed out previously. The epigastric pain disappeared soon after admission and X-ray and endoscopic examinations revealed only a relief convergency on the posterior wall of the upper corpus. The patient complained, however, of such a severe epigastric pain, anorexia, and weightloss again while in the hospital that X-ray and endoscopic examinations were done. X-ray picture showed a depression of irregular shape (about 20 mm in diameter) on the posterior wall of the upper corpus near the greater curvature with surrounding abrupt cessation of mucosal folds converging towards the ulcer and partial swelling of their distal tips on the oral side. Endoscopy revealed a fresh ulcer with white coat and edematous swelling around it on the oral side of the greater curvature away from the previously observed mucosal folds converging. Biopsy from the tips of folds revealed chronic atrophic metaplastic gastritis. The ulcer disappeared after about a half year by therapy with drugs for peptic ulcer, leaving a similar relief convergency as seen at admission X-ray.

　It has been reported that association of Addison's disease with peptic ulcer is of a rare occurrence. So it is suggested in this patient that glucocorticoid treatment for Addison's disease might be associated with such a recurrent gastric ulcer, although causal relation between the two is as yet unknown.