Eight-six Cases of Adison's Disease*
Eight-six Cases of Adison's Disease*
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艾迪生氏病八六例*
DOI：
10.1136/bmj.2.5362.887
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发表时间：
1963
影响因子：
--
通讯作者：
D. Dunlop
中科院分区：
文献类型：
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作者：
D. Dunlop
肾上腺功能减退症在当今并不罕见：肾上腺功能缺陷是垂体功能减退症的结果，这种情况或多或少比过去所认为的更为常见，而且由于神经外科医生在这一领域的活动而变得更加常见;肾上腺皮质的活动，当然，完全停止后双侧肾上腺切除术未知，直到最近几年，但现在越来越多地用于库欣综合征、转移性乳腺癌，甚至偶尔用于高血压;最后，长期持续的皮质类固醇治疗总是伴随着可变和未知时期的功能缺陷，这构成了现代医学的重大问题之一。因此，肾上腺功能减退症的诊断和治疗知识在今天是很重要的，它也是现代医生必须承担的许多新负担之一，而在我年轻的时候，我们相对来说是自由的。然而，我在这里要讨论的并不是这些类型的肾上腺功能减退症，而是托马斯·艾迪生在1855年首次如此优美地描述的一种疾病--一种慢性肾上腺功能不全的状态，是由结核或特发性萎缩引起的肾上腺原发性疾病引起的（可能是类似桥本甲状腺肿的自身免疫反应的结果）;偶尔发生梗死和恶性疾病;很少发生于梅毒、网状细胞瘤和巨细胞肉芽肿。自1928年以来，我亲自照顾了86例阿狄森氏病，并希望这样获得的经验可能会有一些兴趣，如果只是从历史的角度来看。病理学在1928年至1938年期间，我看到了34例，但是，尽管所有这些病人都死了，我只能对其中的24例进行尸检（表I）。其中19例（79%）是由结核病引起的，结核病的发病率高于其他已发表的系列。例如，Guttman（1930）回顾了1900年至1930年期间在不同中心进行的333例Addison病患者的尸检，报告了68%的结核病病因，
Hypoadrenalism is a not uncommon condition nowadays: a defective function of the adrenals occurs as the result of hypopituitarism-a greater or less degree of which condition is more common than used to be supposed, and becoming more so as the result of the activity of the neurosurgeons in this sphere; adrenocortical activity, of course, ceases completely after bilateral adrenalectomyan operation unknown till comparatively recent years, but now increasingly undertaken for Cushing's syndrome, metastatic mammary cancer, and even, occasionally, for hypertension; lastly, defective function for a variable and unknown period always follows long-continued corticosteroid therapy and constitutes one of the great problems of modern medicine. A knowledge of the diagnosis and management of hypoadrenalism is thus of importance nowadays, and creates one of the many new burdens which modern doctors have to assume and of which we were comparatively free in my young days. It is not, however, of these types of hypoadrenalism which I wish to discuss here, but of the disorder first described so beautifully by Thomas Addison in 1855-a state of chronic adrenal insufficiency resulting from primary disease of the adrenals due to tuberculosis or idiopathic atrophy (possibly the result of an autoimmunizing reaction similar to Hashimoto's goitre); occasionally to infarction and malignant disease; and very rarely to syphilis, the reticuloses, and giant-cell granuloma. Since 1928 1 have personally looked after 86 cases of Addison's disease, and hoped that an account of the experience so acquired might be of some interest, if only from a historical point of view. Pathology During 1928 to 1938 1 saw 34 cases, but, though all these patients died, 1 was able to secure necropsies on only 24 of them (Table I). In 19 (79%) of these the disease had resulted from tuberculosis-a higher tuberculous incidence than in other published series. For example, Guttman (1930), reviewing 333 necropsies on patients with Addison's disease conducted in different centres between 1900 and 1930, reported a tuberculous aetiology in 68%, atrophy in