熊波波 張勁松 李寧 王海峰 左毅剛 王劍松

[摘要] 腎上腺結(jié)核多繼發(fā)于肺結(jié)核，少見原發(fā)性，多見雙側(cè)同時(shí)病變，罕見單側(cè)發(fā)病。本文報(bào)道了1例原發(fā)性單側(cè)腎上腺結(jié)核中年男性患者，術(shù)前診斷為腎上腺腫瘤可能，術(shù)后病理學(xué)為腎上腺結(jié)核，出院后給予抗結(jié)核治療，后續(xù)定期完善隨訪觀察。結(jié)合國(guó)內(nèi)外相關(guān)文獻(xiàn)分析，原發(fā)性單側(cè)腎上腺結(jié)核患者往往無明顯癥狀，實(shí)驗(yàn)室檢查指標(biāo)包括結(jié)核菌素試驗(yàn)、血沉、T細(xì)胞斑點(diǎn)試驗(yàn)、皮質(zhì)醇、促腎上腺皮質(zhì)激素、醛固酮及尿香草扁桃酸等，CT檢查方法要優(yōu)于彩超，腎上腺結(jié)核在CT上表現(xiàn)更為清楚，特別對(duì)鈣化點(diǎn)的識(shí)別，術(shù)前活檢是唯一可以明確疾病性質(zhì)的方法，常規(guī)治療方式為抗結(jié)核治療或抗結(jié)核治療聯(lián)合手術(shù)。原發(fā)性單側(cè)腎上腺結(jié)核很少見，應(yīng)結(jié)合患者的影像學(xué)資料來鑒別，必要時(shí)行穿刺活檢術(shù)來明確診斷，避免誤診。

[關(guān)鍵詞] 腎上腺結(jié)核;腎上腺腫瘤;手術(shù)治療;誤診

[中圖分類號(hào)] R529.0 ? ? ? ? ?[文獻(xiàn)標(biāo)識(shí)碼] C ? ? ? ? ?[文章編號(hào)] 1673-9701（2019）32-0138-02

Primary unilateral adrenal tuberculosis of a case report and related literature analysis

XIONG Bobo ZHANG Jinsong LI Ning WANG Haifeng ZUO Yigang WANG Jiansong

Department of Urology， Second Affiliated Hospital of Kunming Medical University， Yunnan Institute of Urology， Kunming ? 650101， China

[Abstract] Adrenal tuberculosis is mostly secondary to tuberculosis; the primary adrenal tuberculosis is rare; and the bilateral lesions are common; and unilateral morbidity is rare. This article reported one case of middle-aged male patient with primary unilateral adrenal tuberculosis. The preoperative diagnosis was adrenal tumor. And the postoperative pathology was adrenal tuberculosis. Anti-tuberculosis treatment was given after discharge. Follow-up was performed regularly. Combined with domestic and international literature analysis， patients with primary unilateral adrenal tuberculosis often have no obvious symptoms. Laboratory tests include tuberculin test， erythrocyte sedimentation rate， T cell spot test（T-SPOT）， cortisol， Adrenocorticotropic hormone（ACTH）， aldosterone and vanilla mandelic acid（VMA）. CT examination is superior to color Doppler ultrasound. Adrenal tuberculosis is more clear on CT， especially for calcification. Preoperative biopsy is the only method that can clarify the nature of the disease. The conventional treatment is anti-tuberculosis treatment or anti-tuberculosis treatment combined with surgery. Although primary unilateral adrenal tuberculosis is rare， we use the patient's imaging data to identify， if necessary， a needle biopsy to confirm the diagnosis and avoid misdiagnosis.

[Key words] Adrenal tuberculosis; Adrenal tumor; Surgical treatment; Misdiagnosis

腎上腺結(jié)核屬于泌尿系結(jié)核中較少見的臨床疾病，繼發(fā)于肺結(jié)核，以雙側(cè)同時(shí)病變多見，單側(cè)發(fā)病罕見[1]。繼發(fā)性腎上腺結(jié)核是結(jié)核菌血行播散至腎上腺，破環(huán)其皮質(zhì)及髓質(zhì)，使腎上腺呈結(jié)核性干酪樣壞死，當(dāng)90%以上的腎上腺組織受到嚴(yán)重破環(huán)，可導(dǎo)致腎上腺皮質(zhì)激素分泌不足，出現(xiàn)愛迪生氏病[2]。腎上腺結(jié)核是愛迪生氏病的主要病因，腎上腺皮質(zhì)激素分泌不足，表現(xiàn)為全身多系統(tǒng)的功能紊亂。原發(fā)性單側(cè)腎上腺結(jié)核患者往往激素分泌不足，相關(guān)癥狀不明顯，通常以患側(cè)腰痛為主訴，目前診斷也無統(tǒng)一標(biāo)準(zhǔn)，影像學(xué)上與腎上腺腫瘤鑒別相對(duì)困難[3]，故原發(fā)性單側(cè)腎上腺結(jié)核在臨床上易誤診為腎上腺腫瘤。本文報(bào)道了本院收治的1例原發(fā)性單側(cè)腎上腺結(jié)核的患者，現(xiàn)報(bào)道如下。

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（收稿日期：2019-07-31）