奥卡姆的剃刀,简约的原则,在医学中经常被用来从患者的无数症状中得出单一诊断。相反,希卡姆的格言,通过考虑对患者的表现进行多重诊断,包含了丰富的原则,通常没有得到充分利用,或者不像奥卡姆的剃刀那样得到广泛认可。在评估疲劳等非特异性症状时,应用希卡姆的格言尤为重要。可以表现在各种疾病中。本报告描述了一名72岁的男性,该男性有乙型肝炎的功能性治愈史,患有慢性疲劳和低钠血症。最初,他被诊断为无功能性垂体大腺瘤和全垂体功能减退症。垂体手术后两个月,消化不良的发作和疲劳的复发揭示了肝脏的转移性肿瘤,胃,胰腺,左肾上腺,和胰周淋巴结.肝活检证实诊断为肝细胞癌。这个案例强调了考虑多重因素的重要性,根据患者的症状和危险因素可能共存,以完成彻底的诊断。此外,它强调有慢性乙型肝炎感染史的患者需要对肝癌的风险保持警惕,不管功能性治疗。
Occam\'s razor, the principle of parsimony, is frequently employed in medicine to derive a single diagnosis from a patient\'s myriad symptoms. Conversely, Hickam\'s dictum, which embraces the principle of plenitude by considering multiple diagnoses for a patient\'s presentation, is often underutilized or not as widely recognized as Occam\'s razor. The application of Hickam\'s dictum is particularly crucial when evaluating nonspecific symptoms such as fatigue, which can manifest in various diseases. This report describes the case of a 72-year-old man with a history of functional cure for hepatitis B who presented with chronic fatigue and hyponatremia. Initially, he was diagnosed with non-functional pituitary macroadenoma and panhypopituitarism. Two months following pituitary surgery, the onset of dyspepsia and the recurrence of fatigue revealed metastatic tumors in the liver, stomach, pancreas, left adrenal gland, and peri-pancreatic lymph nodes. A liver biopsy confirmed the diagnosis of hepatocellular carcinoma. This case highlights the importance of considering multiple, potentially co-existing conditions based on the patient\'s symptoms and risk factors to complete the thorough diagnoses. Additionally, it emphasizes the need to remain vigilant regarding the risk of liver cancer in patients with a history of chronic hepatitis B infection, irrespective of a functional cure.