Addison crisis
The content of the article:
- Causes and risk factors
- Forms of the disease
- Disease stages
- Symptoms
- Diagnostics
- Treatment
- Possible complications and consequences
- Forecast
- Prevention
Addisonic crisis is an acute endocrinological emergency, a complication of chronic adrenal cortex insufficiency. It develops as a result of a sharp decrease or cessation of the synthesis (intake) of corticosteroids and the resulting discrepancy between a small amount of hormones and an increased need for them by the body.
Synonyms: hypoadrenal crisis, adrenal crisis, acute adrenal failure, acute adrenal insufficiency, hypocorticism.
Addison crisis is an acute insufficiency of the adrenal cortex.
Causes and risk factors
The main causes of an Addison crisis against the background of chronic adrenal insufficiency are:
- pregnancy and childbirth;
- alcohol abuse, alcohol intoxication;
- acute infectious and inflammatory conditions, regardless of the localization of the pathological process (the greatest danger is represented by generalized and severe diseases);
- incorrect pharmacotherapy with certain drugs (insulin, diuretics, sedatives, narcotic analgesics);
- physical or psycho-emotional stress;
- surgical interventions;
- injuries to the abdomen and lower back;
- extensive burns;
- unreasonable reduction in the dose of glucocorticoids or sudden cancellation of substitution therapy.
The following factors can provoke the development of an Addison crisis in patients with no history of chronic pathology:
- autoimmune damage to the adrenal cortex;
- Waterhouse-Friederiksen syndrome;
- congenital fermentopathies;
- pathology of the blood coagulation system;
- bilateral acute adrenal cortex infarction;
- overdose of anticoagulants (hemorrhage in the tissue of the cortex);
- bilateral adrenalectomy;
- HIV-associated complex;
- malignant neoplasms of the hypothalamic-pituitary axis;
- acute debut of latent Addison's disease and Schmidt's syndrome.
Addison crisis is a consequence of the complication of chronic adrenal cortex insufficiency
Deficiency of gluco- and mineralocorticoids negatively affects all types of metabolism, which leads to disruption of the formation of endogenous glucose, a decrease in its concentration, a decrease in circulating blood volume, a sharp decrease in blood pressure (blood pressure), severe impairment of renal function, cardiovascular, digestive and nervous systems …
Forms of the disease
There are 4 main forms of Addison crisis, which differ in the prevailing clinical symptoms:
- Gastrointestinal form. It is characterized by symptoms of acute dyspepsia (nausea, indomitable vomiting, loose stools, lack of appetite, up to aversion to food, spastic pain in the epigastrium and abdomen).
- Pseudoperitoneal form. It resembles the symptoms of an acute abdomen (sharp abdominal pains, accompanied by protective tension of the muscles of the anterior abdominal wall).
- Cardiovascular (myocardial, or collaptoid) form. The manifestations of acute circulatory failure (cyanotic staining of the skin and mucous membranes, cold extremities, severe hypotension, tachycardia, threadlike pulse) dominate.
- Neuropsychic (or meningoencephalitic) form. It is characterized by violent focal symptoms, delirium, hallucinations, unbearable headache, convulsions, depression of consciousness or, on the contrary, agitation.
Some authors describe 3 forms of Addison crisis, referring the pseudoperitoneal form to the gastrointestinal one. A number of sources mention the respiratory form of the Addison crisis, manifested by respiratory failure.
In isolation, one form or another is rare in clinical practice; usually acute adrenal insufficiency is accompanied by a combination of different symptoms.
Disease stages
An addisonic crisis develops in a period of several hours to several days, during its course, the pre-crisis stage and the stage of advanced clinical manifestations are distinguished.
In the pre-crisis period, patients are worried about increasing weakness, muscle pain, increased skin pigmentation, decreased blood pressure, loss of appetite.
Symptoms
Signs of an Addison crisis:
- the patient is conscious, but contact with him is difficult (slurred, quiet voice, weakness, apathy);
- turgor and elasticity of the skin are reduced, facial features are pointed, with sunken eye sockets, the skin is dry, hyperpigmented;
- intense dyspeptic disorders, traces of blood may appear in vomit and feces;
- pain in the lumbar region, impaired urination (from a sharp decrease to complete cessation);
- frequent pulse of weak filling and tension, muffling of heart sounds;
- severe hypotension (systolic blood pressure is often below 60 mm Hg, diastolic blood pressure may not be determined);
- pouring sweat;
- decrease in body temperature;
- neurological disorders (convulsions, stupor, stupor, hallucinations, delirium, in severe cases - disorientation in time and place).
Diagnostics
A number of laboratory and instrumental studies are required to confirm acute adrenal insufficiency.
Laboratory diagnostics:
- general blood test (detection of an increase in the number of erythrocytes, leukocytes, eosinophils and hemoglobin, increased ESR);
- biochemical blood test (detecting a decrease in glucose levels, an increase in the amount of urea, creatinine);
- a blood test for electrolytes (detecting a decrease in the level of sodium, chlorides, an increase in potassium);
- general urine analysis (for protein, single cylinders, erythrocytes, sometimes acetone);
- test with ACTH (synacthen).
Instrumental diagnostics consists in conducting an ECG. An increase in the amplitude of the T wave is characteristic of the Addison crisis: it becomes high and pointed; broadening of the QRS complex, slowing of atrioventricular conduction are possible.
ECG - a method for diagnosing adrenal cortex insufficiency
Treatment
Since this condition develops acutely and is an urgent one, massive complex therapy of the developed disorders is necessary:
- intravenous drip rehydration;
- hormone replacement therapy;
- symptomatic therapy of conditions that provoked the crisis (detoxification, anti-shock, hemostatic therapy, antibiotic therapy, etc.).
Addison crisis treatment is aimed at eliminating the developed disorders
Possible complications and consequences
The consequences of an Addison crisis can be:
- collapse, shock;
- life-threatening heart rhythm disturbances;
- acute renal failure;
- coma, death.
Forecast
The first day is critical during the Addison crisis. With timely treatment started, the prognosis is rather favorable, despite the high mortality rate (40-50%).
The prognosis worsens in the presence of concomitant autoimmune diseases.
Prevention
Prevention should be as follows:
- Systematic diagnostics of laboratory parameters in patients with chronic adrenal insufficiency, mandatory dispensary observation.
- Educating patients receiving hormone therapy with corticosteroids on the rules for changing the drug intake regimen in the event of traumatic effects, sudden physical exertion and other non-standard situations.
- Preventive therapy with glucocorticoid hormones in elective high-risk situations.
- Explaining to patients the inadmissibility of abrupt cancellation or unauthorized reduction of the dose of hormones taken.
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Olesya Smolnyakova Therapy, clinical pharmacology and pharmacotherapy About the author
Education: higher, 2004 (GOU VPO "Kursk State Medical University"), specialty "General Medicine", qualification "Doctor". 2008-2012 - Postgraduate student of the Department of Clinical Pharmacology, KSMU, Candidate of Medical Sciences (2013, specialty "Pharmacology, Clinical Pharmacology"). 2014-2015 - professional retraining, specialty "Management in education", FSBEI HPE "KSU".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
