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Symptoms of acute adrenal insufficiency
Last reviewed: 04.07.2025

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The development of acute adrenal insufficiency for patients with chronic adrenal diseases poses a major threat to life.
An Addisonian crisis is characterized by the development of a prodromal pre-crisis state, when the main signs of the disease are noticeably intensified.
This period occurs in patients with chronic adrenal insufficiency. In cases where adrenal function is suddenly impaired as a result of hemorrhage, necrosis, clinical symptoms of acute hypocorticism may develop without precursors. The duration of an Addisonian crisis may vary: from several 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 administration of hormonal therapy. The development of precursors of an Addisonian crisis may also be observed in patients taking replacement therapy if the doses are insufficient for some reason. Symptoms of a pre-crisis state also occur in patients with an undiagnosed form of the disease. Latent chronic adrenal insufficiency is characterized by frequent crises during various stressful conditions. During the prodrome of an Addisonian crisis, the patient's general asthenia increases, appetite worsens, body weight decreases, skin pigmentation increases, pain in the joints and muscles appears, and hypotension increases.
There are various forms of clinical manifestations of acute adrenal insufficiency. Typical for a crisis is the presence of cardiovascular insufficiency, gastrointestinal manifestations and psychoneurological symptoms of varying severity. It is advisable to distinguish a crisis occurring with a predominance of cardiovascular decompensation; acute hypocorticism accompanied by gastrointestinal disorders; a crisis occurring with a predominance of neuropsychiatric symptoms.
In the cardiovascular form, symptoms of vascular insufficiency prevail. Arterial pressure progressively decreases, the pulse becomes weak, heart sounds are muffled, pigmentation increases and due to cyanosis, body temperature decreases, and with further development of these symptoms, collapse develops.
Gastrointestinal manifestations are initially characterized by a complete loss of appetite to the point of disgust for food and even its smell. Then nausea and vomiting occur, which often becomes uncontrollable, and loose stools are added. Repeated vomiting and diarrhea quickly lead to dehydration. Abdominal pains appear, often of a diffuse, spastic nature. Sometimes an acute abdomen with symptoms characteristic of acute appendicitis, pancreatitis, cholecystitis, perforated ulcer, and intestinal obstruction occurs.
An error in diagnosis in patients with Addisonian crisis and surgical intervention can be fatal for them.
During the development of the Addisonian crisis, cerebral disorders appear: epileptic seizures, meningeal symptoms, delusional reactions, inhibition, clouding of consciousness, stupor. CNS disorders are caused by cerebral edema, changes in electrolyte balance, hypoglycemia. Stopping convulsive epileptic seizures in patients with acute hypocorticism with DOXA preparations 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 violation of neuromuscular excitability. Clinically, this is manifested 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 suddenly in children and adults without previous disease of the adrenal cortex, have a number of features. The development of clinical symptoms in Waterhouse-Friderichsen syndrome depends on the degree of destruction of the adrenal cortex.
In children, the most common cause of acute adrenal insufficiency is Waterhouse-Friderichsen syndrome. Asphyxia, birth trauma, infectious processes (flu, scarlet fever, diphtheria) can lead to acute destruction of the adrenal cortex. The pathogenetic basis of the syndrome is infectious shock, leading to acute vascular spasm, hemorrhages and necrosis of the cortex and medulla of the adrenal glands, as well as post-traumatic adrenal infarction. Clinical manifestations of acute adrenal insufficiency in childhood develop quickly. Within a few hours, the child becomes lethargic, refuses to eat, has a fever, develops muscle twitching, and abdominal pain. Later, blood pressure drops, meningeal symptoms appear, and loss of consciousness occurs.
In adults, Waterhouse-Friderichsen syndrome most often occurs during surgical stress, the use of coagulants, and childbirth. During large, long operations, the use of various drugs for anesthesia and pain relief that are activators of the hypothalamic-pituitary-adrenal system can lead to adrenal infarction. Acute massive hemorrhage in the adrenal glands is accompanied by sudden collapse states. Arterial pressure progressively decreases, petechial rash appears on the skin, body temperature rises, signs of acute heart failure occur - cyanosis, shortness of breath, rapid small pulse. Sometimes the leading symptom is severe abdominal pain, more often in the right half, or periumbilical region. In some cases, symptoms of internal bleeding occur. In the clinical picture of acute adrenal insufficiency, in addition to the symptoms characteristic of a crisis, it is always possible to detect disorders that are the causes of its occurrence: sepsis, infections, most often pneumonia, bronchitis, surgical stress.