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Acute adrenal insufficiency: an overview of information
Last reviewed: 23.04.2024
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[Causes of acute adrenal insufficiency
Adrenal or addison crises develop more often in patients with primary or secondary adrenal involvement. Less common in patients without previous adrenal diseases.
Decompensation of metabolic processes in patients with chronic adrenal insufficiency, resulting from inadequate replacement therapy against acute infections, trauma, surgeries, climate change and severe physical exertion, is accompanied by the development of an acute form of the disease. Development addisonicheskim crisis is sometimes the first manifestation of the disease with a latent and undiagnosed Addison's disease, the syndrome of Schmidt. Acute adrenal insufficiency constantly threatens patients with bilateral adrenalectomy, performed in patients with Isenko-Cushing's disease and other conditions.
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.
Diagnosis of acute adrenal insufficiency
For the diagnosis of acute adrenal insufficiency, it is important to have anamnestic indications of the adrenal gland that were previously available in patients. More often adrenal crises occur in patients with a reduced function of the adrenal cortex for various extreme conditions of the body. Insufficient secretion of the adrenal cortex occurs with primary adrenal damage and secondary hypocorticism caused by a decrease in ACTH secretion.
Adrenal disease includes Addison's disease and congenital dysfunction of the adrenal cortex. If the patient has any autoimmune disease: thyroiditis, diabetes mellitus or anemia - one can think of Addison's autoimmune disease. Primary adrenal insufficiency or Addison's disease sometimes develops due to tuberculosis lesions.
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Treatment of acute adrenal insufficiency
In acute adrenal insufficiency, it is urgent to use replacement therapy with synthetic drugs of gluco- and mineralocorticoid action, as well as to carry out measures to remove the patient from the shock state. In time, the treatment started leaves more opportunities to get the patient out of the crisis. The most dangerous for life are the first day of acute hypocorticism. In medical practice, there is no difference between the crisis in patients who developed with the aggravation of addison's disease after removal of the adrenal gland and a coma that occurred as a result of acute destruction of the adrenal cortex in other diseases.
From preparations of glucocorticoid action in conditions of acute adrenal insufficiency it is necessary to give preference to hydrocortisone. It is injected intravenously and drip, for this use hydrocortisone hemiscuic or adzizon (cortisone).