問題詳情
1. 陳小姐,36 歲 ,身高 160 公分,體重 73 公斤,最近兩年,體重自 58 公斤增加至目前之體重。無個人或家族之糖尿病史。最近兩年,數次在家中或工作場所,因昏倒意識不清,送至急診就醫,曾於急診發現血糖值為 32mg/dL,在注射 50%葡萄糖液後恢復意識。之後,曾於神經內科及家庭醫學科就醫複查,並未發現神經學異常或糖尿病。本次再度因意識狀態不清,送至急診就醫,急診血糖值為 28 mg/dL,注射葡萄糖液後恢復意識,清醒後,在急診亦無神經學異常症狀,因此建議住院進一步追查原因。在病房住院時,空腹 8 小時,並無輸液下,空腹血糖為 86mg/dL,ACTH 36.5pg/mL, Cortisol 16.8 ug/dL, Insulin 1.6mIU/mL, C-peptide 2.2 ng/mL, TSH 1.62 mIU/mL。請問下一步應該建議那一項檢查?
(A) 75 公克葡萄糖耐受試驗
(B) Overnight 1mg Dexamathasone suppression 測試
(C) 腦下垂體磁振攝影 (Pituitary MRI)
(D) 72 小時之 Prolonged fasting test
(E) 腹部電腦斷層檢查
(A) 75 公克葡萄糖耐受試驗
(B) Overnight 1mg Dexamathasone suppression 測試
(C) 腦下垂體磁振攝影 (Pituitary MRI)
(D) 72 小時之 Prolonged fasting test
(E) 腹部電腦斷層檢查
參考答案
答案:D
難度:適中0.5
統計:A(0),B(0),C(0),D(0),E(0)
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