Suy thượng thận do sử dụng lạm dụng Glucocorticoid: Báo cáo ca bệnh và tổng quan y văn

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Tác giả: Văn Linh Phạm

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Khoa học Sức khỏe, 2023

Mô tả vật lý: tr.173

Bộ sưu tập: Metadata

ID: 340243

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Bối cảnh: Glucocorticosteroid (hay corticosteroid, corticoid) là nhóm thuốc tổng hợp có hoạt tính chống viêm được chỉ định điều trị tương đối phổ biến trong thực hành lâm sàng song cũng do hoạt tính và tác dụng kiểm soát nhanh triệu chứng của các đợt bệnh cấp tính, nhóm thuốc này cũng bị sử dụng sai hay lạm dụng rất nhiều đặc biệt bên ngoài các bệnh viện, có thể đưa đến nhiều hậu quả và biến chứng ảnh hưởng nhiều tới sức khoẻ người bệnh, thậm chí có thể đe doạ sinh mạng khi không được chẩn đoán và điều trị kịp thời. Ca bệnh: Bệnh nhân 83 tuổi, có tiền sử đau khớp
vào viện cấp cứu trong tình trạng mệt nhiều, chán ăn, chóng mặt, đau bụng dữ dội, tiểu buốt, khát
dấu hiệu sinh tồn có tần số tim 100 nhịp/phút, huyết áp 100/60 mmHg, nhiệt độ 36,5 độ C
khám lâm sàng, thăm dò và xét nghiệm ghi nhận ngoại hình Cushing, các dấu hiệu nhiễm trùng và mất nước, hình ảnh gan nhiễm mỡ và dày thành bàng quang, natri máu giảm. Nhập viện tại khoa Ngoại, sau loại trừ “bụng ngoại khoa” người bệnh được chuyển sang Khoa Nội. Tại khoa Nội người bệnh của được chẩn đoán suy thượng thận cấp (và hội chứng Cushing) liên quan tới sử dụng corticoid. Diễn biến thuận lợi trong vòng 6 giờ sau điều trị, người bệnh xuất viện sau 13 ngày. Kết luận: Sử dụng corticoid toàn thân hay tại chỗ không theo chỉ định và hướng dẫn có nguy cơ đưa tới suy thượng thận, trong một số tình huống với các biểu hiện nặng, cấp tính, đe doạ sinh mạng. Cần nghĩ đến để nhận ra và xử lý kịp thời, giảm nguy cơ tử vong.Context: Glucocorticosteroid (or corticosteroid) are a group of synthetic drugs with anti-inflammatory activity that are commonly indicated in clinical practice, but also is also misused or abused a lot due to their activity and rapid symptom control effect during acute illness. The abuse of these drugs, especially outside hospitals, can lead to many consequences and complications that could affect greatly the patient's health, or be life threatening if not diagnosed and treated promptly. Case report: An 83-year-old woman with history of arthralgia
admitted to the emergency room with multiple symptoms including extreme fatigue, loss of appetite, dizziness, severe abdominal pain, dysuria and thirst
vital signs with HR 100 beats/min, BP 100/60 mmHg, temperature of 36.5oC
Clinical examination and workups noted Cushingoid appearance,signs of infection and dehydration, steatosis (fatty liver) and bladder wall thickening images, and hyponatremia. Admitted to the Surgery, after excluding surgical abdomen, the patient was transferred to Internal Medicine department where an acute tertiary adrenal insufficiency (and Cushing's syndrome) related to corticosteroid use were diagnosed. Clinicial status progresses favorably within 6 hours, the patient was discharged after 13 days with medical prescription and appointment for outpatient follow-up. Conclusions: The using of corticosteroids systemically or locally in automedication basis or not strictly complying to the indications and instructions has the risk of leading to adrenal crisis, and in some situations with acute severe or life-threatening state. Health care professionals should keep in mind and think about to recognize and treat promptly, reducing the risk of death.

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