一位73歲男性以全身無力為表現

A 73-Year-Old Man Presented with Generalized Weakness

年長者全身無力原因甚多，其中老年衰弱症（frailty）多為進展緩慢且合併活動力降低、體重減輕、肌肉耗損甚至認知功能障礙，而降壓藥、利尿劑引發的無力常會表現姿勢性低血壓、頭暈或電解質異常，鎮靜安眠藥物則常見無力及日間嗜睡狀況。腎上腺功能不全為容易忽略之鑑別診斷，除漸進性全身無力，也可能合併噁心、嘔吐及食慾不振，若急性惡化且表現低血壓、休克或意識改變則稱為腎上腺危象，需立即治療且存在死亡風險。本案例是一位剛診斷新型冠狀病毒感染之73歲老年患者，因全身無力及食慾不振至本院求治，發現為嚴重低血鈉，經灌注生理食鹽水仍進步緩慢，再次回顧病史發現個案有腦下垂體功能低下症但近期未規則服用類固醇、身體檢查及實驗室報告有腎上腺皮促素及皮質酮偏低，故診斷為腎上腺功能不全誘發腎上腺危象，改以針劑類固醇治療後其症狀迅速改善。腎上腺危象的診斷需仰賴臨床照護者在病史及臨床評估上的高度警覺，治療時亦須儘早提高類固醇劑量補充，以免疾病進展迅速嚴重，威脅患者生命。

Generalized weakness in older adults has a broad differential diagnosis. Frailty typically presents as a slowly progressive syndrome associated with decreased mobility, weight loss, sarcopenia, and cogni¬tive decline. Medication-related weakness, including that caused by antihypertensive agents, diuretics, and sedative–hypnotics, is often accompanied by orthostatic hypotension, dizziness, electrolyte dis¬turbances, or daytime somnolence. Adrenal insufficiency is an important but frequently overlooked cause of generalized weakness. In addition to progressive generalized weakness, it may present with nausea, vomiting, and loss of appetite. Acute deterioration with hypotension, shock, or altered mental status constitutes adrenal crisis, a life-threatening emergency requiring immediate treatment. We re¬port the case of a 73-year-old man with a recent diagnosis of coronavirus disease 2019 (COVID-19) who presented with generalized weakness and poor appetite. Laboratory testing revealed severe hypo-natremia, and his clinical condition improved only minimally after isotonic saline infusion. Further review of his medical history revealed underlying hypopituitarism and recent nonadherence to steroid replacement therapy. Physical examination and hormonal studies demonstrated low levels of adreno¬corticotropic hormone (ACTH) and cortisol, confirming the diagnosis of adrenal crisis secondary to adrenal insufficiency. After initiation of intravenous glucocorticoid therapy, his symptoms improved rapidly. This case highlights the importance of maintaining a high index of suspicion for adrenal crisis in elderly patients presenting with nonspecific symptoms such as generalized weakness, particularly in those with known pituitary or adrenal disorders. Early recognition and prompt escalation of glucocor¬ticoid replacement are critical to prevent rapid clinical deterioration and potentially fatal outcomes.