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患者男,56岁。2005年1月因意识障碍6 h,大小便失禁,四肢厥冷,急诊血压难以测出,体温不升,外院脑和垂体 CT 未见明显异常,血糖1.5 mmol/L,静推葡萄糖后升至2.8 mmol/L,转入本院。既往史:1984年曾患流行性出血热,出院后渐渐觉得畏寒、乏力、纳差、性欲下降、眉毛胡须脱落、记忆力减退、便秘、耳聋,易感冒。曾到外院就诊,诊断为贫血,治疗效果欠佳。半月前因左侧面部感染在外院予以抗炎治疗,近1周畏冷、乏力加重,常跌倒。既往无外伤、大出血、骨折、结核感染及放射线接触史。体检:血压测不出,体温35%,P:20次/min,R:16次/min,呈浅昏迷,面色苍白,无胡须,眉毛稀疏,眼睑浮肿,瞳孔直径3mm,项强三指,呼吸浅慢,双肺可闻及湿罗音,四肢肌张力增强,腱反射减弱。睾丸萎缩,无阴毛。实验室检查 AST 142 u/L,LDH 438 u/L,CK-MB 127 u/L,CK 2609 u/L,tc,空腹血糖1.9 mmol/L,Na 116 mmol/L,K 3.8 mmol/L,Cl 88 mmol/L,CO_2CP
Male patient, 56 years old. January 2005 due to disturbance of consciousness 6 h, incontinence, extremities Jueleng, emergency blood pressure is difficult to measure, body temperature does not rise, outside the hospital brain and pituitary CT no significant abnormalities, blood glucose 1.5 mmol / L, intravenous glucose rose to 2.8 mmol / L, transferred to our hospital. Past history: 1984 had epidemic hemorrhagic fever, gradually felt chills, fatigue, anorexia, loss of libido, eyebrow beard off, memory loss, constipation, deafness, and cold easily after discharge. Had to the outside hospital for treatment, diagnosis of anemia, poor treatment. Half a month ago because of the left side of the facial infection in the hospital to be anti-inflammatory treatment, nearly 1 week cold, fatigue, often fall. No previous trauma, bleeding, fractures, tuberculosis and radiation exposure history. Physical examination: blood pressure can not be measured, body temperature 35%, P: 20 times / min, R: 16 times / min, was shallow coma, pale, bearded, eyebrows sparse, eyelid edema, pupil diameter 3mm, Slow breathing, lungs can smell wet rales, limb muscle tension increased, tendon reflexes. Testicular atrophy, no pubic hair. Laboratory tests showed that AST 142 u / L, LDH 438 u / L, CK-MB 127 u / L, CK 2609 u / L, tc, fasting plasma glucose 1.9 mmol / L, Cl 88 mmol / L, CO_2CP