每日一题_2023.09.09

A 28-year-old woman presents to her physician with concerns that she is unable to produce breast milk, despite having given birth approximately one month ago. On further questioning she indicates she has been exceptionally thirsty lately, and describes feelings of fatigue and cold intolerance. Physical examination reveals no abnormalities except a scarcity of axillary hair. Laboratory tests reveal a serum sodium level of 150 mEq/L and urinalysis reveals a urine osmolality of 220 mOsmol/kg. Which of the following most likely increased the patient’s risk of developing this condition?

一名28岁的女性到她的医生处就诊，担心她无法产生母乳，尽管她大约一个月前已经分娩。在进一步的询问中，她表示她最近特别口渴，并描述了疲劳和不耐冷的感觉。体格检查除腋毛稀少外无其他异常。实验室检查显示血清钠水平为150 mEq/L，尿液分析显示尿液渗透压为220 mOsmol/kg。下列哪一项最有可能增加患者患这种疾病的风险?

(A) Abnormalities of the placenta 胎盘异常

(B) Alcohol intake during pregnancy 怀孕期间饮酒

(C) Endometriosis 子宫内膜异位

(D) Gestational diabetes妊娠糖尿病

(E) Incorrect use of tampons卫生棉条使用不当

(F) Multiple sexual partners多个性伴侣

(G) Pelvic inflammatory disease盆腔炎性疾病

答案解析：

该患者表现为席汉综合征或产后垂体坏死，由分娩时出血引起。危险因素包括多胎妊娠(双胎或三胎)和胎盘异常。围产期出血使已经增大的垂体发生缺血，导致部分垂体前叶和(或)垂体后叶坏死。席汉综合征最常见的临床特征是由于垂体前叶受损和泌乳素生成减少而导致的不能分泌乳酸。其他症状包括甲状腺功能减退症(如患者对寒冷的不耐受)，以及由抗利尿激素产生减少引起的中枢性尿崩症(DI)。DI表现为在血清钠水平升高的情况下出现多尿和稀尿。FSH和LH水平降低常导致闭经和阴毛和腋毛生长不足。治疗包括对所有缺乏的激素进行终身激素替代疗法，同时补充雌激素和孕激素。

正确答案：A