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体受体放射性核素治疗诱导的超皮质血压危机在异位库希综合征
Raghavendra Pandit1, Chethan Yamichannaiah1, Anurag Ranjan Lila1
1Department of Endocrinology, Seth G. S. Medical College and K. E. M. Hospital, Mumbai, Maharashtra 400012, India.
JCEM case reports
|October 2, 2025
概括
一名患者在受体放射性核化物治疗 (PRRT) 后经历了严重的高皮质醇危机. 埃托米达的输液可以控制皮质醇水平,但需要精确的监测需要液体染色学-并列质谱法 (LC-MS/MS).
科学领域:
- 内分泌学 在内分泌学.
- 在瘤学瘤学.
- 核医学是一种核医学.
背景情况:
- 转移性宫外库辛综合征是由胸膜神经内分泌瘤引起的,具有诊断和治疗方面的挑战.
- 用-177标记DOTA-[Tyr3]-octreotate (177Lu-DOTATATE) 的受体放射性核酸疗法 (PRRT) 是神经内分泌瘤的治疗方式.
- 急性 adrenocorticotropin (ACTH) 介导的高皮质醇危机是高皮质醇症的危及生命的并发症.
研究的目的:
- 报告一例罕见的通过PRRT诱导的ACTH介导的高皮质血压危机,该病例发生在患有宫外库辛综合征的患者身上.
- 为了突出治疗急性高皮质血症的方法,使用埃托米达输液.
- 要强调诊断挑战和液体染色学-并联质谱学 (LC-MS/MS) 的必要性,以便在接受PRRT治疗的患者中进行准确的生化监测.
主要方法:
- 一个用177Lu-DOTATATE PRRT治疗的转移性子宫外丘辛综合征妇女的案例研究.
- 急性管理涉及低剂量静脉注射埃托米达输液作为双边上腺切除术的桥梁.
- 生物化学监测使用化学发光测定和LC-MS/MS进行准确的皮质醇和类固醇前体评估.
主要成果:
- 患者在PRRT启动5天后出现了急性ACTH介导的高皮质醇危机,其特征是严重的高皮质醇和高血压.
- 埃托米达的输液导致临床上腺功能不足 (低血压),尽管在化学发光试验中皮质醇水平持续高,这表明试验干扰.
- LC-MS/MS分析证实了准确的皮质醇水平,并且患者可以耐受后续的PRRT循环.
结论:
- 在患有宫外库辛综合征的患者中,PRRT可以导致ACTH介导的高皮质血压危机.
- 埃托米达对急性皮质醇控制有效,但生物化学监测需要仔细解释,因为可能会干扰测试.
- 在PRRT和潜在的类固醇前体积累的背景下,LC-MS/MS对于准确诊断和管理高皮质醇症至关重要.
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