Acute adrenocortical insufficiency - is critical to the body a medical emergency. It develops a sharp reduction or complete absence of adrenal hormones in the blood. This condition can develop when a sharp increase in demand for adrenocortical hormones, if production of hormones can not cover the increased need has arisen.
Acute adrenocortical insufficiency is accompanied by:
sharp drop in pressure
severe muscle weakness up to the immobility
varying degrees of impaired consciousness.
Acute adrenocortical insufficiency may occur in the newborn due to hemorrhage in the adrenal glands during heavy and prolonged labor due to birth trauma or exposure to various infections. This condition is called syndrome Waterhouse-Friderichsen. In this product the right amount of adrenal hormones (mainly corticosteroids) is not possible because of the defeat gormonprodutsiruyuschey tissue of adrenal glands. In adults and older people in the adrenal hemorrhage can occur against a background of trauma abdomen and chest, with an overdose of anticoagulants in surgical interventions, sepsis, peritonitis, burns.
Acute adrenocortical insufficiency may develop:
against the background of already existing chronic insufficiency of adrenal hormones (Addison's disease)
the surgical removal of the adrenal glands on the pituitary Cushing syndrome (Nelson) with sharp cancellation of glucocorticoids, designated to treat.
The cause of acute adrenal insufficiency may be an autoimmune thyroiditis (Schmidt's syndrome). In case of insufficiency of the adrenal cortex decreases sharply in the blood content of hormones - glucocorticoids and mineralocorticoids. At the same time the body loses its ability to adapt to stressful situations.
Insufficient number of mineralocorticoids (aldosterone) leads to a drastic reduction in the amount of sodium in the body, water loss, decrease in total blood volume. The level of potassium, which leads to a weakening of the heart muscle, cardiac arrhythmias, slow heart rate. Lack of glucocorticoids (cortisol) violates the gastrointestinal tract, which is accompanied by vomiting and diarrhea. There is a violation of the metabolism of carbohydrates, accompanied by a decrease in the amount of glucose in the blood. Violated almost all types of metabolism.
Acute adrenal insufficiency develops suddenly. The first symptoms are usually:
abrupt onset muscle weakness
temperature rise to high numbers
headache
nausea and vomiting
sharp drop in blood pressure.
Then it becomes repeated vomiting, aching abdominal pain, diarrhea. The pressure continues to fall. This is accompanied by chills, cold sweats, cold extremities. Blood pressure can not raise the standard drugs.
There are disturbances of consciousness (lethargy, stupor, sometimes accompanied by hallucinations, mental stimulation). May cause seizures with convulsions similar to epileptic seizure.
Due to the drop in blood pressure and reduce blood volume is greatly disturbed the kidneys and urine output is terminated.
Within hours, the patient's condition progressively deteriorated and can be fatal.
Treatment of acute adrenal insufficiency.
If there is suspicion of acute adrenocortical insufficiency need urgent hospitalization in intensive care unit.
The primary treatment of acute adrenal insufficiency is the intravenous administration of corticosteroids. Usually assigned to hydrocortisone intravenously, then move on intravenous drip infusion. Along with hydrocortisone assigned solution of sodium chloride and glucose. Correction is carried out elekrolitov content, protein and carbohydrates in the blood. In the steady decline in blood pressure additionally injected mineralocorticoids (Dox) or epinephrine, norepinephrine.
After several days of treatment assigned to drink plenty of liquids. After 10 days of starting treatment the patient is transferred to tablet preparations of glucocorticoids.
For the prevention of acute adrenal insufficiency in patients with Addison's disease in trauma, surgery, acute exacerbation of chronic diseases is necessary to increase the dose of prescribed drugs glucocorticoids.
