Acute adrenal insufficiency

Acute adrenal insufficiency.  Photo from www.sciencephoto.com

Acute adrenal failure (addisonichesky crisis) — An acute serious condition that occurs as a result of a sharp reduction or elimination of the production of hormones by the adrenal cortex.

Causes

Acute failure adrenocortical most often occurs in patients with chronic adrenal insufficiency. For example, if they stop taking hormones, corticosteroids, making up for the lack of their own. The same thing can happen on a background of injury, surgery, acute infectious diseases, climate change, heavy physical exertion, severe emotional stress.

In addition, addisonichesky crisis happens:

  • in acute adrenal hemorrhage or developing them infarction (tissue necrosis);
  • meningitis, sepsis, severe blood loss (injury, childbirth), burns.

What's going on?

The adrenal glands almost completely stop producing hormones, which leads to a violation of all kinds of metabolism. First, the sharp dehydration occurs and decreases the amount of circulating blood. The metabolism of potassium leads to the fact that the heart muscle begins to decline worse. Simultaneously suffers carbohydrate metabolism: reduced blood sugar level, increases the sensitivity of cells to insulin. Disrupted the kidneys.

The human condition suddenly and rapidly deteriorated:

Adrenal crisis develop during the period from several hours to several days. In predkrizovom period increases muscle weakness, appetite disappears, aching muscles.

The symptoms of acute adrenal insufficiency (crisis):

  • dramatically reduced blood pressure, which is manifested copious sweat, cold hands and feet, sudden weakness;
  • disrupted the heart develops an arrhythmia;
  • nausea and vomiting, severe abdominal pain, diarrhea;
  • sharply reduced urine excretion (oligoanuria);
  • impaired consciousness. Initially, the patient is languid, barely speaks, his voice quiet, nevniyatny. Then there are hallucinations, fainting, coma occurs.

If you notice such symptoms need immediate hospitalization.

Diagnosis and treatment

For the diagnosis of acute adrenal insufficiency is prescribed:

  • Complete blood. Marked increase in the number of red blood cells (polycythemia) and hemoglobin (due to thickening of the blood), increased white blood cell count and erythrocyte sedimentation rate;
  • Blood sugar: hypoglycemia (lowering blood sugar);
  • Biochemical analysis of blood: the marked increase in the level of potassium and creatinine, decreased level of sodium chloride;
  • General urine analysis: protein is determined, red blood cells, sometimes acetone;
  • Investigation of adrenal hormone levels in urine and blood: revealed a sharp decrease in the number of corticosteroids (cortisol, aldosterone, and others);
  • ECG signs of hyperkalemia.

Treatment is carried out in an intensive care unit or intensive care unit.

The mainstay of treatment — a dropper with corticosteroids and special solutions. There are also activities for the removal of the patient from a state of shock. If treatment is started in time, the chances of a crisis to bring the patient increase.

After recovery, patients are signs of dysfunction of the adrenal glands, so they need lifelong replacement therapy with synthetic analogs of adrenal hormones.

Prophylaxis

In order to prevent adrenal crisis is necessary to conduct an adequate hormone replacement therapy in chronic adrenal insufficiency and other conditions requiring continuous use of corticosteroids.

In any case you can not manually stop taking corticosteroids, or reduce their dosage. Need to constantly keep in touch withEndocrinologists, which adjusts the dose of medication depending on the physical activity and state of health of the patient.

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