@article{oai:redcross.repo.nii.ac.jp:02001551,
 author = {重松, 太樹 and 新山, 優 and 岡田, 貴典},
 issue = {1},
 journal = {松山赤十字病院医学雑誌, The Matsuyama Red Cross Hospital Journal of Medicine},
 month = {Dec},
 note = {グルココルチコイド含有薬剤の急激な断薬が原因と考えられる2次性副腎不全の一例を報告する．症例は70代男性，脳梗塞後の呼吸状態悪化と意識障害の原因精査目的に前医より転院となった．来院時呼吸状態悪化，JCS3桁の意識障害，低血圧，頻脈を認め，ショック状態であった．精査のためヒドロコルチゾンを投与し造影 CT を撮影したが，有意な所見はなかった．血液検査で血中ナトリウム濃度は正常範囲内であったが，高カルシウム血症を認めた．第2病日にショック状態から離脱し，その直後から下痢が出現，第6病日より食思不振の出現で経口摂
取不可となった．高カルシウム血症，嘔吐，下痢の症状から精査を行い2次性副腎不全と診断した．グルココルチコイド補充で症状は改善し，第41病日に転院となった．グルココルチコイド中止に伴う副腎不全は2次性副腎不全の原因で最多である．副腎不全は低ナトリウム血症が主要症状として知られているが，2次性副腎不全は副腎からのアルドステロ
ン分泌が保たれるため，低ナトリウム血症を示さないことがある．一方で，頻度としては少ないが，副腎不全患者の 7％で高カルシウム血症を示すことが報告されており，本症例のように低ナトリウム血症は伴わなくても，高カルシウム血症に嘔吐・下痢の症状が合わさったときには副腎不全を鑑別に挙げる必要がある．, We present a case of secondary adrenal insufficiency, potentially triggered by the sudden discontinuation of glucocorticoid-containing medications. A70-years-old man was transferred from a previous medical facility for an investigation into worsening respiratory status and impaired consciousness following a cerebral infarction. Upon arrival at our hospital, the patient exhibited signs of shock, deteriorating respiratory function, impaired consciousness（with a Japanese Coma
Scale score in the 3-digit range）, hypotension, and tachycardia. Hydrocortisone was promptly administered, and a contrast-enhanced computed tomography scan was performed ; however, this yielded no significant findings. Blood tests revealed normal serum sodium levels but indicated the presence of hypercalcemia. On the second day of hospitalization, the patient emerged from shock ; however, on the sixth day, hey developed diarrhea and anorexia, rendering oral intake
impossible. A comprehensive evaluation, considering the symptoms of hypercalcemia, vomiting, and diarrhea, led to the patient being diagnosed with secondary adrenal insufficiency. His clinical
condition notably improved following glucocorticoid replacement therapy, ultimately resulting in his transfer to another medical facility on the 41st day of hospitalization. This case underscores the frequent association between glucocorticoid discontinuation and secondary adrenal
insufficiency. While hyponatremia is recognized as a hallmark of adrenal insufficiency, secondary adrenal insufficiency may not necessarily manifest with hyponatremia due to the preserved secretion of aldosterone by the adrenal glands. Conversely, hypercalcemia has been documented in 7% of patients with adrenal insufficiency. Therefore, as exemplified in this case, clinicians should consider adrenal insufficiency as part of the differential diagnosis when hypercalcemia cooccurs with symptoms such as vomiting and diarrhea, even in the absence of hyponatremia.},
 pages = {65--71},
 title = {高カルシウム血症と嘔吐・下痢が 診断の契機となった2次性副腎不全の一例},
 volume = {48},
 year = {2023}
}