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69歳,女性.1989年頃から悪心,食思不振出現.最近,症状増悪し1992年3月9日来院.心電図上巨大陰性T波を認めたため精査入院.臨床検査では軽度の貧血を認め血中Naは130mEq/lと低値.血中ACTH,コルチゾールの基礎値はともに低く,インスリン低血糖試験でGHは正常反応を示すもACTHは無反応.ACTH-Z試験にコルチゾールは反応し,CRF試験にACTHは反応せず.TSH試験LH-RH試験は正常反応.以上より下垂体性ACTH単独欠損症と診断した.コルチゾール補充療法で症状は改善し心電図異常も消失した.後日心血管造影,心筋生検を施行したが異常はなかった.特異な心電図変化にて発見され,コルチゾール補充療法にて心電図変化の改善を認めたACTH単独欠損症の1例を経験したので報告する.
The case is that of a 69-year-old woman who had developed nausea and anorexia in 1989, and who came to our hospital with recently aggravated symptoms on March 3, 1992. Giant negative T wave on ECG led to her hospitalization for detailed examinations. Clinical examinations revealed serum Na of as low as 130 mEq/l and low basal values of both blood ACTH and con tisol. GH showed normal reaction during an insulin hypoglycemia test, but ACTH did not. Cortisol reacted to a ACTH-Z test, but ACTH did not react to a CRF test. TSH test and LH-RH test indicated normal reactions.
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