Adrenal, addisonic crisis or acute insufficiency of the cortical zone of the adrenal glands is an extreme and severe manifestation. Adi ssona disease. Accompanied by a decrease in the functional activity of the adrenal cortex. Such crises are very difficult, occur against the background of severe physical or emotional stress, and often lead to death.
The main reason for the formation of adrenal crisis – a sharp cessation of the adrenal cortex, a sharp decrease in the level of adrenal cortex hormones in the blood. This usually occurs in the following cases:
- with the abolition of hormone replacement drugs in people with Addison ’s disease,
- in case of injury to the adrenal gland or surgery
- with acute generalized infections and sepsis with necrosis of the adrenal cortex,
- with hemorrhages in the adrenal cortex,
- with severe blood loss or burn disease.
As a result of all these causes, there is a critical decrease in the amount of hormones produced by the adrenal cortex. As a result, there is a loss of fluid and dehydration with simultaneous loss of potassium, impaired functioning of the heart muscle and other muscles of the body. Carbohydrate metabolism suffers, which leads to renal failure. In a short time, a person may fall into a coma.
Adrenal crisis may develop within a few hours, less than a few days. Initially, muscle pain and severe weakness manifest, appetite is disturbed. Signs of an upcoming crisis are:
- sharp drop in pressure
- arrhythmia, a sense of disruption of the heart,
- heavy sweating
- cold extremity, chills,
- severe weakness with inability to stand
- diarrhea, nausea and vomiting,
- sharp and severe abdominal pain,
- a sharp decrease in the amount of urine,
- speech difficulty, fainting, hallucinations,
- development of coma.
With the appearance of such symptoms, urgent hospitalization in the intensive care unit with the introduction of a whole complex of drugs is necessary.
In an adrenal crisis, a blood test is urgently carried out, in which there will be a sharp leukocytosis and an accelerated ESR, a sharp increase in red blood cells.Wherein blood glucose sharply below normal. The amount of electrolytes — sodium, potassium, and chlorine — decreases sharply, and creatinine decreases.In the analysis of urine detected acetone, protein and red blood cells .
In the analysis of blood levels of hormones, a sharp decrease in the level of hormones of the adrenal cortex – corticosteroids. When conducting an ECG revealed a violation of the conductivity of the heart.
Treatment of adrenal crisis is carried out in the intensive care unit – corticosteroid therapy is carried out with individual dose selection, as well as drip infusion of electrolyte solutions and glucose. An anti-shock therapy is carried out.
- Emergency hospitalization is indicated.
- Intravenously administered 0.9% sodium chloride solution to eliminate dehydration, hydrocortisone. Clinical improvement (assessed primarily by the restoration of blood pressure) usually occurs 4–6 hours after intravenous therapy.
- When the temperature rises (against the background of normal blood pressure), antipyretics, such as paracetamol, are prescribed.
- During surgical interventions, it is necessary to adjust the dose of steroid hormones.
- Prevention of infectious diseases.
Usually, after an adrenal crisis, you have to be on hormone replacement therapy for life, since the adrenal glands can no longer work as before, they are irreversibly damaged.
The patient will be registered for life at the endocrinologist for life, the doses of the drugs will be constantly adjusted.