Renal tubular acidosis complicated with hyponatremia due to cortisol insufficiency.
Renal tubular acidosis complicated with hyponatremia due to cortisol insufficiency.
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DOI：
10.1093/omcr/omv063
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发表时间：
2015-11
影响因子：
0.5
通讯作者：
Mukoyama M
中科院分区：
文献类型：
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作者：
Izumi Y;Nakayama Y;Onoue T;Inoue H;Mukoyama M
肾上腺皮质功能不全，如发生在阿狄森氏病引起低钠血症和肾小管酸中毒（RTA）。低钠血症是由醛固酮和皮质醇不足引起的。RTA是由于醛固酮不足。皮质醇在RTA中的参与尚不清楚。在这里，我们报告了一位70多岁的女性，她因严重低钠血症（106 mEq/l）和RTA而入院。患者表现出低血浆皮质醇水平，对快速促肾上腺皮质激素负荷几乎没有反应。与此相反，血浆醛固酮浓度维持在或高于正常范围。氢化可的松替代大大改善了低钠血症和RTA。这个病例提示醛固酮和皮质醇都参与了肾脏的酸分泌。
Adrenocortical insufficiency such as occurs in Addison's disease causes hyponatremia and renal tubular acidosis (RTA). Hyponatremia results from both aldosterone and cortisol insufficiency. RTA is due to aldosterone insufficiency. The involvement of cortisol in RTA is unclear. Here, we report a woman in her 70s who was admitted to our hospital with severe hyponatremia (106 mEq/l) and RTA. The patient exhibited low plasma cortisol levels with little response to rapid adrenocorticotropic hormone loading. In contrast, the plasma aldosterone concentration was maintained at or above the normal range. Hydrocortisone replacement greatly improved both the hyponatremia and RTA. This case suggests that both aldosterone and cortisol are involved in acid secretion from the kidney.