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张××,女,37岁,住院号:A59858。病人10年前,妊娠6个月时出现头痛、头晕、乏力、肥胖。产后诊断柯兴病,行双肾上腺次全切除术,病理证实为双肾上腺皮质增生。术后恢复良好,但始终无月经。血压高,最高达29.3/18.7kPa。近一年时有视物不清。入院前2天,病人突然剧烈头痛、呕吐,继之意识不清,全身抽搐约10分钟,醒后左侧肢体活动不灵。入院查体:血压17.4/11.6kPa,嗜睡,向心性肥胖,满月脸,水牛背。神经系统检查:右眼底可见片状出血,视乳头水肿,左侧中枢性面、舌下神经瘫,左上、下肢肌力Ⅳ级,左偏身痛觉减退,脑膜刺激征(+)。实验室检查:血皮质醇389μg/L,口服地塞米松8mg 后12小
Zhang × ×, female, 37 years old, hospital number: A59858. 10 years ago, the patient had headache, dizziness, weakness and obesity at 6 months of pregnancy. Post-natal diagnosis of Coxing disease, line adrenal subtotal resection, the pathology confirmed as double adrenal hyperplasia. Postoperative recovery is good, but always without menstruation. High blood pressure, up to 29.3 / 18.7kPa. Nearly a year when blurred vision. 2 days before admission, the patient suddenly severe headache, vomiting, followed by unconsciousness, convulsions for about 10 minutes, woke up after the left limb movement is not working. Admission examination: blood pressure 17.4 / 11.6kPa, lethargy, concentric obesity, full moon face, buffalo back. Nervous system examination: the right fundus hemorrhage visible, papilledema, left central plane, hypoglossal nerve paralysis, left upper quadrant muscle strength Ⅳ, left partial body pain relief, meningeal irritation (+). Laboratory tests: blood cortisol 389μg / L, oral dexamethasone 8mg after 12 small