One case of missed diagnosis of multiple organ dysfunction syndrome complicated with adrenal crisis and literature review

doi:10.3969/j.issn.1004-583X.2023.04.012

Abstract

Abstract:

Objective To discuss the clinical features, diagnosis and treatment points, and causes of misdiagnosis and missed diagnosis of multiple organ dysfunction syndrome (MODS) complicated with adrenal crisis (AC). Methods A retrospective analysis was conducted on the medical records of one case of missed diagnosis of MODS complicated with AC.Results A 48-year-old male patient was admitted to hospital with vomiting and diarrhea for 2 days, drowsiness for 1 day and loss of consciousness for 10 minutes. Due to high fever, low blood pressure, high pro-calcitonin and lactic acid, combined with abnormal liver and kidney function and coagulation function, the patient was diagnosed as intestinal infection with septic shock and MODS. Symptomatic supportive treatment including anti-infection, organ support, and maintaining internal environment stability was actively given. However, there was no significant improvement in the degree of shock and consciousness disorder compared with admission. After repeatedly asking about the medical history, the family members complained that the patient was in good health in the past, and then a physical examination was given again. It was found that the patient's whole body skin was dark, except for work reasons, it was considered that this situation was caused by endocrine system diseases. After examining the hormone levels, the patient was diagnosed as AC, and 2.5 mg of prednisolone acetate was given orally once a day. The dosage of prednisolone acetate was adjusted based on the rechecked hormone levels, and the symptoms were quickly corrected. Conclusion For healthy population without underlying diseases, the early clinical features of AC are often manifested as respiratory tract, digestive tract and neurological symptoms, which are prone to miss diagnosis and misdiagnosis. Doctors should strengthen the understanding of this disease, provide early treatment with glucocorticoid, identify the cause of AC, and give active treatment.

Key words: adrenal diseases, multiple organ failure, shock, septic, missed diagnosis

CLC Number:

R586.9

Gao Weikang, Quan Jianhua, Niu Xinrong. One case of missed diagnosis of multiple organ dysfunction syndrome complicated with adrenal crisis and literature review[J]. Clinical Focus, 2023, 38(4): 356-358.

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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2023.04.012

https://huicui.hebmu.edu.cn/EN/Y2023/V38/I4/356

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