Symptoms of acute adrenal insufficiency

The development of acute adrenal insufficiency for patients with chronic adrenal diseases presents a great threat to life.

The addisonian crisis is characterized by the development of the prodromal pre-cirrus state, when the main signs of the disease are markedly increased.

This period occurs in patients with chronic adrenal insufficiency. In cases where adrenal function is disturbed suddenly as a result of hemorrhage, necrosis, the clinical symptoms of acute hypocorticism can develop without precursors. The time of the Addison's crisis can vary from a few hours to several days. It depends on the degree of adrenal insufficiency, the cause of the crisis, the general condition of the body and the time of the appointment of hormone therapy. The development of precursors of the Addisonian crisis can also be observed in patients taking substitution therapy, if the doses are insufficient for some reason. Symptoms of the pre-cirrus state also appear in patients with undiagnosed form of the disease. For the latent flowing chronic adrenal insufficiency, frequent occurrence of crises under various stress conditions is characteristic. During the period of the addison's crisis prodrome, the patient's general asthenia grows, appetite worsens, body weight decreases, pigmentation of the skin becomes worse, joint and muscle pains occur, and hypotension develops.

There are various forms of clinical manifestations of acute adrenal insufficiency. Typical for a crisis is the presence of cardiovascular failure, gastrointestinal manifestations and psychoneurological symptoms of varying severity. It is advisable to identify a crisis that occurs with a predominance of cardiovascular decompensation; acute hypokorticism, accompanied by gastrointestinal disorders; crisis, occurring with a predominance of neuropsychic symptoms.

With a cardiovascular form, the symptoms of vascular insufficiency predominate. Progressively lowering blood pressure, the pulse becomes weak filling, heart tones are deaf, pigmentation is increased and due to cyanosis, body temperature decreases, with further development of these symptoms, collapse develops.

Gastrointestinal manifestations are initially characterized by a complete loss of appetite before aversion to food and even a smell from it. Then there is nausea, vomiting, which often becomes indomitable, joins a loose stool. Multiple vomiting and diarrhea quickly lead to dehydration of the body. There are pains in the abdomen, which are more often spilled spasmodic. Sometimes there is a picture of an acute abdomen with characteristic symptoms for acute appendicitis, pancreatitis, cholecystitis, perforated ulcer, intestinal obstruction.

An error in diagnosis in patients with an addisonic crisis and surgical intervention may be fatal for them.

During the development of the addisonian crisis, cerebral disorders appear: epileptic convulsions, meningeal symptoms, delusional reactions, inhibition, darkening of consciousness, stupor. The CNS disorders are caused by brain edema, changes in electrolyte balance, hypoglycemia. The cessation of convulsive epileptic seizures in patients during acute hypokorticism with Doxa drugs gives a better therapeutic effect than various anticonvulsants. An increase in the potassium content in plasma in patients with acute adrenal insufficiency leads to a breakdown in neuromuscular excitability. Clinically, this manifests itself in the form of paresthesia, conduction disorders of superficial and deep sensitivity. Muscle cramps develop as a result of a decrease in extracellular fluid.

Clinical manifestations of acute adrenal insufficiency, which begins in children and adults suddenly without a previous disease of the adrenal cortex, have a number of characteristics. The development of clinical symptoms depends on the syndrome of Waterhouse-Frideriksen on the degree of destruction of the adrenal cortex.

In children, the cause of acute adrenal insufficiency is often the Waterhouse-Frideriksen syndrome. Asphyxia, birth trauma, infectious processes (influenza, scarlet fever, diphtheria) can lead to severe destruction of the adrenal cortex. The pathogenetic basis of the syndrome is an infectious shock leading to acute vascular spasm, hemorrhages and necrosis of the cortex and adrenal medulla, as well as posttraumatic infarction of the adrenal glands. Clinical manifestations of acute adrenal insufficiency in childhood develop rapidly. Within a few hours the child becomes sluggish, refuses food, his body temperature rises, convulsive twitching of muscles, pain in the abdomen. In the future, the fall in blood pressure, there are meningeal symptoms, a loss of consciousness.

In adults, Waterhouse-Friderixen syndrome often occurs with surgical stress, the use of coagulants, and childbirth. For large, long-term operations, the application of anesthesia and anesthesia for various drugs that are activators of the hypothalamic-pituitary-adrenal system can lead to an adrenal infarction. Acute massive hemorrhage to the adrenal glands is accompanied by sudden collapsoid states. Progressively lowering blood pressure, a petechial rash appears on the skin, the body temperature rises, signs of acute heart failure - cyanosis, shortness of breath, rapid pulse. Sometimes the leading symptom is severe pain in the abdomen, more often in the right half, or near the umbilical region. In some cases, symptoms of internal bleeding occur. In the clinical picture of acute adrenal insufficiency, in addition to the symptoms characteristic of the crisis, it is always possible to detect abnormalities that are the causes of its occurrence: sepsis, infections, more often pneumonia, bronchitis, operational stress.

[1], [2], [3], [4], [5], [6]