我们报道了一名47岁的男性患者的头部色素沉着,脸和手,最初被诊断为原发性肾上腺功能不全(Addison病)。实验室测试,影像学和体格检查显示亚临床甲状腺功能减退症,高循环催乳素和雌二醇浓度,妇科乳房发育症,淋巴结病,脾肿大和双下肢无力。这些发现使我们考虑该患者是否存在单个或多个疾病。的确,艾迪生的疾病可以代表更广泛的全身性疾病的一个方面。因此,我们做了进一步的检查,并发现高血清M蛋白(5.1%)和血管内皮生长因子[1005.30pg/mL(正常范围0至142pg/mL)]浓度。因此,我们诊断出多发性神经病,器官肿大,内分泌病,单克隆丙种球蛋白病和皮肤变化(POEMS)综合征。因此,当单个疾病不能完全解释一个患者的多种症状和体征时,临床医生应考虑出现更广泛综合征的可能性,并进行更详细的诊断测试.
We report the case of a 47-year-old male patient with pigmentation of the head, face and hands, who was initially diagnosed as having primary adrenal insufficiency (Addison\'s disease). Laboratory testing, imaging and physical examination revealed subclinical hypothyroidism, high circulating prolactin and oestradiol concentrations, gynaecomastia, lymphadenopathy, splenomegaly and weakness of both lower limbs. These findings led us to consider whether a single or multiple diseases were present in this patient. Indeed, Addison\'s disease can represent one aspect of a wider systemic disease. Therefore, we performed further examinations, and found high serum M protein (5.1%) and vascular endothelial growth factor [1005.30 pg/mL (normal range 0 to 142 pg/mL)] concentrations. As a consequence, we diagnosed polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy and skin changes (POEMS) syndrome. Consequently, when a single disease cannot fully explain the multiple symptoms and signs of one patient, clinicians should consider the possibility of the presence of a wider syndrome and undertake more detailed diagnostic testing.