Addisonic Crisis (acute insufficiency of the adrenal cortex)

What is Addisonic Crisis?

Acute insufficiency of the adrenal cortex (addisonic crisis) is a comatose state resulting from a sharp decrease in the production of hormones by the adrenal cortex (all of these, except for stress hormones).

Causes of Addisonic Crisis

Acute insufficiency of the adrenal cortex most often occurs in patients with chronic adrenal insufficiency. For example, if they stop taking hormones, corticosteroids, which compensate for the lack of their own. The same can happen after injuries, surgeries and serious infectious diseases.

In addition, an addisonic crisis happens:

  • in case of acute hemorrhage in the adrenal glands or during the development of a heart attack in them (a nidus of dead tissue);
  • failure in immunity, when the body’s defenses begin to damage the cells of their own adrenal glands (systemic lupus erythematosus, periarteritis nodosa);
  • also acute insufficiency of the adrenal cortex can complicate such conditions as meningitis, sepsis, severe blood loss (injuries, childbirth).

Pathogenesis during Addisonic Crisis

The adrenal glands almost completely stop producing hormones. As a result, terrible things begin to happen to the human body.

First of all, there is a sharp dehydration of the body and decreases the amount (volume) of blood. Disruption of potassium metabolism leads to the fact that the heart muscle begins to decline worse. At the same time, carbohydrate metabolism suffers: the level of sugar in the blood decreases, the sensitivity of cells to insulin increases. Kidneys do not cope with their work.

Symptoms of Addisonic Crisis

The condition of a person suddenly and very quickly deteriorates:

  • blood pressure decreases sharply, which is manifested by abundant sweat, cooling hands and feet;
  • heart function is disturbed, arrhythmia develops;
  • nausea and vomiting, severe abdominal pain, diarrhea;
  • the consciousness changes: there are hallucinations, a syncope, then a coma occurs.

When these symptoms appear, you must immediately call an ambulance.

Diagnosis of Addisonic Crisis

The diagnosis is established on the basis of the inspection and the following studies:

  • biochemical blood test: an increase in the level of potassium and creatinine, a decrease in the level of sodium;
  • study of the level of adrenal hormones in the urine and in the blood: a sharp decrease in the number of corticosteroids (cortisol, aldosterone, etc.) is detected.

Treatment of Addisonic Crisis

The treatment is carried out in the intensive care unit or intensive care.

The basis of treatment is droppers with corticosteroids and special solutions. If treatment is started on time, the patient can be saved.

Treatment is ineffective if the development of acute insufficiency of the adrenal cortex complicated the course of a serious infectious disease (meningitis, sepsis).

To prevent the onset of the disease, it is necessary to conduct adequate hormone replacement therapy in case of chronic insufficiency of the adrenal cortex and other diseases that require constant administration of corticosteroids.

In no case should you stop taking corticosteroids yourself or reduce their dosage. It is necessary to constantly maintain contact with the endocrinologist, who adjusts the dose of the medicine depending on the physical activity and the patient’s state of health.

Prevention of Addisonic Crisis

Patients who already have problems with the work of the adrenal cortex, to avoid a crisis, you must constantly carry out hormone replacement therapy – to take corticosteroids.

In any case, it is impossible to suspend the intake of these hormones or reduce the dosage. In addition, it is necessary from time to time to visit the endocrinologist. It will help to prescribe the correct dosage, taking into account the health and physical activity of the patient.

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